OS Informed 2023 New Years Reflections for International Occupational Therapy with Dr. Michael Sy

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I was so inspired to reach out to Dr. Michael Sy as my first official guest on the Engaging OS podcast outside of the Foundations of Occupational Science course because I loved his reflections and resolutions for the international OT community to consider in relation to his own cultural context of the Philippines.

One of the aspects of Occupational Science that I love is how it can inspire us to grow through connection and dialog with our international peers.  I believe we have so much to learn from each other and our own rapidly changing and developing cultural context.

The new year invites us all to reflect and contemplate how we might utilize our agency for intentional growth and change.  I hope this conversation inspires you to reflect on your own practice and consider how Occupational Science can enhance our awareness and practice in collaboration with our international peers and scholars. We have so much to learn from each other.

If you would like to explore Dr.  Micheal Sy's work deeper invite you to explore the following:
Dr. Michael Sy's New Years Reflections and Resolutions
Website: https://www.drmikesyot.com/
Facebook: https://www.facebook.com/drmikesyot
YouTube: https://www.youtube.com/user/michaelsyotrp
ReserachGate: https://www.researchgate.net/profile/Michael-Sy 

Works Referenced in this episode:

Theorising Occupational Therapy Practice in Diverse Settings

Edited By Jennifer Creek, Nick Pollard, Michael Allen

Social Occupational Therapy: Theoretical and Practical Designs By Roseli Esquerdo Lopes &  Ana Paula Serrata Malfitano

Yao, D. P. G., Sy, M. P., Martinez, P. G. V., & Laboy, E. C. (2022). Is occupational therapy an ableist health profession? A critical reflection on ableism and occupational therapy. Cadernos Brasileiros de Terapia Ocupacional, 30, e3303. https://doi.org/10.1590/2526-8910.ctoRE252733032

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Transcript

0:04

Hello everyone. Thank you for checking out this first episode of the engaging occupational science podcast. Um, this is our initial bonds in the 2023 new year. I really wanted to invite one of my more anticipated guests of the occupational scientists. Mike sigh. So Mike sigh, he also goes by more formally Michael Tsai, M I C H E L S Y. If you want to check out some of his more formally published works. For example, he has a profile available on research gate. Orchid Google scholar. Highly recommend checking out his work as an occupational scientist. He does really amazing work around the occupation. Of beauty and looking at the dark side. Have a beauty pageants in particular, in the Philippines context. So I reached out to Mike side early in, um, or sorry, rather late in December, because he had some really amazing reflections about, you know, new year learning resolutions. Um, reflections for OT practice in the context of the Philippines, uh, he had five key takeaway points that he wanted OTPs in the Philippines context to consider in going into the new year. That was really motivated for me to reach out and seeking might be. Be open to discussing some of these takeaway of reflections. More in-depth in the context of the podcast. And to highlight what benefit we can gain by engaging in dialogue, across cultural contexts. Because one of the things I love about occupational science in particular is. How much we can enhance our practice by engaging in global dialogue across difference. And acknowledging that we now live and work in a cultural, multicultural, global society. So having conversations about how. Multiculturalism impacts the modern context that we all inhabit. Um, you know, his first reflection that we talk about relates to, um, a social challenge that's happening in the context of the Philippines, where. Occupational therapy practitioners. Are having a hard time, like making the choice to stay in the Philippines and they're finding opportunities. Outside of their cultural context to serve clients all over the world, especially here in the us. And, you know, really that does have some considerations for us to think about. How we can be in really compassionate and solidarity with their international peers to help meet the occupational needs all over the world. Which is something that is, you know, important for us that are in the United States, in Canada, in Europe, to be mindful of, of when we have OTs migrating. Two other cultural contexts to serve our clients here. How can we also be supportive and welcoming and thinking about what it means to make our services accessible on the global scale? That's certainly something that we need to be thinking about. If we're going to be truly advancing human rights and the consideration for the most marginalized amongst our global community. Um, and so we got to really hit that in this conversation, which I love, we really covered a lot of territory in just about an hour and a half of dialogue. That can help bring more awareness to some of the core conversations and topics within occupational science, but also prompt us to reflect as occupational therapists, no matter what con cultural contexts we come from. The new year. Is a great prompt to really incorporate more reflective practices, not only in our own life, but also considering how can we advance our goals as a profession and how can we be more mindfully connected to our science base and. Be responsive to the changes that we're experiencing globally. Um, as we go into new opportunities and challenges, how do we retain an optimistic and proactive mindset? That really is the new year. The new year prompts us to reflect on the previous year and to think about what we can do with our agency and our goals. And how can we resource ourselves to respond to change. And to challenge and hopefully broaden our perspective too. Respond to these challenges in a way that not only enhances our own lives, but Hans is our clients enhances our communities. And it brings us more connected into a degree of international solidarity and wellbeing for the occupational needs. That really are. You know, connected throughout this planet. I think. If you haven't walked away from the COVID 19 pandemic. That's still ongoing without this understanding that viruses don't care about borders and, um, health needs and conflict. It just creates more demand for our service, more importance for an occupational lens. Um, I think the new year invites us all to really connect deeper to our role on this planet and what we want our work and our legacy to look like. Um, so I'm really excited to share this conversation with you and hopefully invite you to reflect on your own life, your own practices in OT, and to consider. You know what we might learn from other cultural contexts and how they're adapting, um, across these borders and how we can support and learn from each other. So thank you. And I invite you to hopefully start your new year off. With some inspiration as brought forward by Mike sigh. He really has an amazing body of work. And thank you so much for joining on this initial episode with more to come this year. Thank you.

Josie Jarvis: 6:23

welcome everyone. This is the first really live episode of the Engaging Occupational Science Podcast.

6:31

This the first recording outside of the Foundation of Occupational Science course. So I'm so excited to welcome all of us that are listening to this into the new year. And the person I was so excited to have on as the first guest is Dr. Michael Sy goes by Mike Sy, believe informally. Mike, I believe that you have a PhD in occupational science in addition to being a practicing occupational therapist. And did you have the full duration of your career develop in the Philippines? Is that accurate to say or can you speak to that? Hi everyone. I'm Mike, and thank you very much Josephine for inviting me here. To answer your question I did my education and training and occupational therapy in the Philippines, but I did my PhD in Tokyo in Japan, so I did it there for three years. And from there I got exposed to different international practices and practices from different contexts and of course knowledges and ideas from different cultures. Yeah, amazing. So very relevant topics of discussion, especially within occupational science, and I think that are becoming more and. At the surface of occupational therapy practice. I think certainly internationally, and I know that some of these conversations are starting to bubble up in the United States, and I think that's why it's so important for most OTPs, really throughout the world. And, I'm passionate about the occupational science deficit in particular that we have here in the United States. So despite the fact that occupational science maybe started here in the United States and certainly it j the development in Japan is such a huge contribution to this body of work. So I'm so glad that you've gotten to connect. Really what I've learned so far is occupational science has almost always been an international collaborative effort since the beginning. And that's part of why I was excited to have you on in the new year. This idea of having kind of new year reflections. I read that one of your most recent published works is about having a reflexive practice as OTs and win better than the new year to reflect back and think about, what can we do with our agency? But to me, occupational science asks that question of. There are structures, there are oppressive f forces often in our cultural context that we navigate. And it's so common that we can look at the barriers. And I think the occupational science also empowers us to look at the opportunities and how we can, utilize our agency as well. So new year resolutions, it's a great way to both reflect and to think about where might we take our Kawa rivers in this journey together. It's a great opportunity to hopefully build some community around these questions. So I'm really curious to see are there overlaps potential in US-based OT and how OT is developing in the Philippines, and what can we learn from each other and model maybe utilizing somewhat of an occupational science lens while we engage in some of these questions. Does that sound good for you? Yeah. Sure. Yeah, Perfect. Before we start too, I was curious because I know that you started your career before going into academia as an occupational therapist, and I've been wanting to encourage those that are joining the conversation about occupational science. Some people think that occupational science is really only an academic discipline and maybe it doesn't have much to do with occupational therapy in general. And what I think that I've noticed in engaging in the occupational science world for the past couple years is that a majority of occupational scientists that I've met so far, Do have experience working as clinicians. Do you mind speaking a little bit about your journey towards occupational science and how you identify today as an occupational therapist and how you integrate those two? Yeah. I was introduced to occupational science in OT school. I think I was in the first year of my studies there. So that was years ago. And it was just def it was defined as an academic discipline, but I really didn't know that. Occupational sciences about research and about generating knowledge more than the therapy that we do in occupational therapy. I know that they have a synergistic relationship. They are they're symbiotic in, in some ways. But when I went into my PhD, which is a very academic exercise I was introduced to it more because I took occupational science classes with my professor. I was also able to take a doctoral course in Karolinska instituted in Sweden in occupational science to, to learn about occupational science in Europe. And, as you go to different regions and study about occupational science, there's beauty in the diversity that we see and how occupational science are being studied in different regions of the world. Although, like you mentioned historically, occupational science originated from the United States and, any academic discipline can originate from anywhere. The good thing about my, my study in occupational science is that. what I learned is that occupational science does not just inform occupational therapy. It can inform other disciplines in other professions. And I think that's the good thing about it. And that's something that we need to foreground because there is this re reductionist rhetoric where OTs would think that o s informs our practice or occupational therapy informs occupational science scholarship. Yes, there's synergy in that, but we fail to realize the capacity or the ability of this academic discipline, which is occupational science, providing insights to public health, providing insights to social work. And even medicine, in, in other fields. So I think that's the beauty of occupational science for me. I hope I I was able to answer your question threads too, to come up in this discussion today too, because one of it sounds like one of your passion projects in the context of the Philippines and likely in a broader international conversation too, is looking at how do we collaborate interprofessionally and how do we use the insights of a, kind of a broader ecosystem of human service support professionals working in the diversity of cultural context. That part of getting out of our silos and thinking in kind of an individualistic way and kind of prioritizing our profession before our purpose or we, can miss the forest for the trees. And I think that's a, and a wonderful invitation that I've experienced through engaging with occupational science is the permission to view a broader scope and to, really take on what it means. That there is such great diversity in the context of human doing, being, becoming belonging, and in a true scientific effort, it's welcome to have a diversity of opinions and for there to be some honesty about the lack of certainty that might be an emerging and new phenomena. And I think that, prompts us to be reflective and accountable to new learning, and open to listening. And I think that's a really healthy effort that we, I've heard some people have discourse around occupational science, especially that has been happening in Australia and parts of that where they'll say, oh, this is maybe reverse colonialism if they're bringing more of a social service mind to the United States. Maybe they're imposing their cultural ideas over here and Yeah. I wanna be I think that there's something really beautiful about learning from the diversity of experiences on the human planets. And I think that we can find likely, when I was reading through your post where you have, let see here five different key takeaways that you were reflecting about the Philippines context in relation to occupational therapy of ways that we can consider potentials of improvement over time. And I was surprised that I could really connect to some of what you were reflecting about that have echoes of similarities to some of occupational the's challenges here in the United States. And I think that the conversation can be more made more rich by learning from the diversity of cultural perspectives and how we can view OT as something that can continue to evolve over time. And occupational science invites us to do that. Thank you for letting me muse on that point. But maybe we can look a little bit on some of your reflections about OT in the Philippines, and feel free to interject some of your research interests and what you've been taking away from some of your current work that you're excited about. One of the first points you brought up is that in the Philippines it seems like there may be a challenge within the profession of occupational therapy, of losing occupational therapists. Do you mind speaking to that? Yes. Josephine this is not a new. Dilemma or not a new issue that we face? The diaspora of occupational therapists from the Philippines have been happening since the 1980s. And it's just a cycle. It the pro the, there is a professional exchange wherein, for example, this year it will be the OTs who are leaving, and then next year it will be the nurses, the next year will be the physical therapists. So it's a cycle, and I'm not zeroing into occupational therapy, but really healthcare professionals and even teachers yeah the migration has different impetus, should I say. There, there are so many factors that really let or allow occupational therapists to leave. And one of, one of them could be. Of course, personal and professional growth. Of course many of our OTs would go to the United States. That's the top destination. The United Kingdom, Australia, New Zealand, the Middle East and any English speaking region. We, we also have OT migrants to to Europe. But of course it's more difficult to, to be registered there if you don't speak the language. The, of course, professional and per personal growth and I will not deny. It's really about getting a more secure financial stability because you have that, that really allows you to do more things for yourself, achieve your goals, and that, that's fine. That's totally fine. And of course the there's also this reason of, I wanted, they want to study more. They wanted to to do more advanced training on a certain approach. And that's always available in the United States. Mm. And in other countries, of course, we also have those opportunities here, but it's just more limited. It hasn't been same thing to, to have that in that. When I read you reflecting on this, it really prompted me to think about at least in the United States, that I can gather with how the pandemic has impacted healthcare entirely. I don't know if you're exposed to this chaos theory at all. Complexity theory views complexity theory in occupational science. I'm sure it's a conversation that's more broad than occupational science. Um, But it's, that's how I got to connected to it. And one of the, I think it was more so I'm trying to think of, quantum Leadership Theory is one of the chapters in a leadership textbook I have on ot. And it really struck me as what I was seeing in lifetime in the hospital system that I was working in during the pandemic because with I guess the logic of capitalism in some ways you o oftentimes like salaries have been driven so low and a lot of full-time employees feel systematically underappreciated, undervalued that it's more profitable for the system to exploit healthcare labor to whatever extent they can. And then it's almost created this rupture where now travel and agency companies are providing. Long-term staffing and we're creating this crisis of it not making sense for a lot of healthcare professionals and human service professionals to be committed to their work setting and to be stabilized. I think it is making rise some really interesting questions about what, and maybe some potentialities of envisioning what our health and human service system can look like. With, bargaining. So it seems like those are similar questions that you're happening in the Philippines as well. Yeah. Is how can we build and retain a workforce that can meet the needs of our communities, and also bringing in that sometimes I think it's like this myth that we are totally separate nation states that all operate totally separate from each other because like you were saying, there a lot of therapists from the Philippines are going to Europe, going to parts of Canada, going to the United States. And so these questions are relevant to us as well that are al the receiving end, I think, asking questions. How do we make all of our work environments supportive to bring out the best of OTs no matter where they're coming from I in the international globe? And why I think we need to actually think somewhat internationally about labor rights and human service organizations and how we could collaborate mindfully. Yeah. I have a comment on that about how the system wants more production, yet they also want to lessen the expenses or the cost. And I think one of, one of the concepts that is related to that is called Managerialism. Managerialism is investing the whole healthcare system around the world. And OT is, cannot escape that system. And there's a chapter by Jennifer Creek in the newly published book called Theorizing Occupational Therapy Practice in Diverse Settings. So I'm going to cite that chapter. And I've read that and I just wanted to give a brief overview to comment on what you've just said, that sometimes because there are so many patients then, and the health workforce is becoming more diverse as well, so there's a need to manage. And that's fine when you manage people, when you manage your patient, that's okay. But there will come a time wherein the managerialism overpowers authentic care to the people that we help. And the problem with, The good thing first with Managerialism it allows system to work to operate, but once that's in, and when Managerialism or management overpowers authentic care, we lose that authentic caring for our patients. And that's the problem. For example, if you see a very, a critical patient with so many complex issues and an OT wanted to get to the history, occupational profile of the patient, but hey, you can spend more than an hour talking to the patient because, hey, you have other patients, you need to move, you need to move rooms. And that's managerialism. And, but when you look back and reflect, I did do my job. I wanted to know how he wants to put on makeup, to make her feel good to participate in the therapy session. I wanted to know how she wants to eat again, because she's not motivated to do anything, but we can't do that if we are constantly clashing with this concept on managerialism. And on another note, just to add about the migration topic is that since healthcare system around the world is trying to reduce their costs, but increase the productivity so they get migrants because migrants can be paid cheaper. Okay. So that's, that, that's the thing. And I, I don't have a reference for this, but it's just how it is because I have a lot of od friends who flew to the United States, and when you ask them, how did you get there? Of course they got there through an agency like a recruitment employment agency. And normally an American OT would get, for example,$70 per hour or$100 per hour for a patient. But if you are a migrant OT from the Philippines, for example, and. Work in the United States, and you are there because of an agency. So your pay is not$70 or$100 because there has to be a cut for the agency. So how much do you get half of what an American O would get. And that's good for this system because they don't need to pay as much, but they still get the productivity that they need. So that's why there is this system and it's happening, it's ongoing and I don't know, no one can stop this. This has been happening for decades and yeah, I'm doing a research on OT migrants, Filipino migrants to different countries. That's why I'm able to, Resonate and say this with some level of confidence that, that it's ha it's happening. And sadly some, I'm not saying all, but some migrant OTs say that sometimes their experience in other countries when they're hired as OTs would border human trafficking for some. That's kinda what makes sense. It's ma making me on guard and I, it's something that I've been tangentially aware and part I feel that I have a little bit of an occupational justice issue just in my own upbringing where a lot of the United States educational system they don't take you, you don't get introduced very mindfully to human mean to geography and human cultures. there's so many systemic biases and how things so forgive me that I have likely a lot of ignorance about the Philippines in general and that's why I'm so open to learn. But I have been concerned about contemporary capitalism and industry and to what extent specifically the Philippines and other things are also being kind of labor being exploited because I know that the. Virtual assistant, like I see a lot of people on online talking about how, oh, you can get somebody in the Philippines and pay them$5 an hour to run your whole business and things like that. And um, I think this is why it's so important for those of us that care about human rights, which occupational science really encourages every occupational science scholar that I've interacted with across the globe has a strong anchoring in values around upholding human rights for all human beings. And many are even extending that too to non-human, entities. And I think that's so important. And so I think having an occupational science lens, one of the gifts that it can give us is occupational therapy professionals, no matter where we're practicing, is a vehicle to be in solidarity with our human counterpoint parts and understand that occupational needs and exploitation matters everywhere across the globe and we're linked. And so I think it's a good challenge that say if you are in a corporate rehab system that maybe is part with agency staffing we're actually more powerful together as OT professionals. Watching the best for each other. I think we need to start to see a rising vote lifts all tides as occupational therapy. We're stronger if our occupational science no, sorry, occupational therapy, assistances are well-resourced, offered living wages where they work and are empowered to use the best practices. The best science, the best knowledge. and that's, that doubles internationally. We should want OT to be strong in every nation. And we really should up-level the value of OT no matter what. Cause if, especially if, like in my area, I live in Washington state which is pretty diverse, I think, with migratory labor. And I think I, I do need to be more aware of where the exploitation could be happening. Mm-hmm. but to me it's an asset. If somebody's coming from another cultural context that's adding value to our organization, it really shouldn't be something where they're undervalued because then we get into a downward spiral where all of OT labor can be undervalued and we're not being treated. Our values around human writes. Yeah, I think I just wanted to add that, having an occupational science lens allows us to become more intentional and conscientious of what's happening around us. And the thing with ex, you use the term exploitation and I think the one issue or one problem is These, they don't know that they're being exploited. that's the thing. Because they just see like the system from a from another country like the US or the developed countries, that everything there works, everything there is fine. Because of the higher salary, sometimes people would think very simplistic that when the higher, the salary is higher than what you get here, it's better. That's why they get to the app, they get that opportunity to go there. Of course, I'm not generalizing and just saying that it's happening and it could happen. So what happens with the OT migrants who stay there for a certain period of time, like five years, and if you get your residence residency or perhaps getting a green card, then you can get out of that agency and you can actually get the salary that you're supposed to get as an American. There's a transition period where. And that's why there is corporations, businesses and that's how it works. But we need to be more aware of how things work and like you said, look at human rights, is their welfare okay? Are they doing well, et cetera. So yeah. So I can talk more and more about that, but yeah, I think and that, I think it could hopefully challenge those of us that, like if you're in the United States, there's a lot of concern that I've tracked around social media amongst therapists and healthcare professionals from a variety of different contexts that are very concerned about how productivity, declining rates of reimbursement and salary skills and the getting rid of like meaningful benefits in the healthcare sector. And I think it's I think it can be both personally and professionally strategic mm-hmm. to adopt a broader lens than just really centering ourselves. I think when we center ourselves in those conversations, we're not thinking about the implications for our clients and for our coworkers that are the most likely to be exploited in our system. We're actually stronger when we think about the whole collective and get involved and try to breed a culture of solidarity and interprofessional collaboration. You actually have more power and more leverage within these organizations to help everyone's occupational needs get met. And I think that's like, When I think that way, I feel like I'm true to the spirit of the founding of occupational therapy that was very concerned about the impacts of industrialization on the quality of our physical, mental personal health and just how much we lose our humanity when we get caught up in the forces of industrialization, colonialism, imperialism. And I think that when you engage with occupational science and hopefully especially in the future with occupational therapy, it's almost a way of maybe injecting the humanity back into these conversations. So I think I love that you're bringing up that this is something to be aware of in the Philippines, and I think mutually the US should also be aware of this or, and other contexts that are on the receiving ends of what it means to have a labor force that gets shifted around and how do we interact with these conversations. And for those of you that are joining and are interested in this, hopefully you'll find that os in particular is a great context to start engaging some of these questions. So one of the other points that you brought up is that the, that telehealth has perhaps been undermined in the Philippines in particular, and I thought maybe you could speak a little bit to that and where you see the potential of telehealth in the future. Yes. If if I may comment on this I'm also doing a study on the telehealth experience of service users here in the Philippines during the pandemic. And telehealth has been used in medicine before the pandemic here in the Philippines, but OTs only started using it more when the lockdowns happened. The speech therapists have been using telehealth even before the OTs did. So they're very, how do you say? They're very adapt in, in using telehealth and they're just so comfortable using it. But when the lockdown came OT started to learn about telehealth more. And so during the two years of lockdowns and restrictions here in the Philippines many clients would avail the telehealth. They really need therapy, or some of them just withdrew from therapy services. Because of course they're not comfortable with telehealth. They feel like there's there's difficulty with internet connectivity and many other concerns. So they just dropped off from the roster. But now that the restrictions are easing and starting to go back to the clinics do not. Protective equipments anymore. And it's now more easy to go into clinics and hospitals. I have observed that many of the OTs I know just went back to go back to the clinics. And I feel like telehealth is not just an alternative during the pandemic. telehealth is an approach that you can use to enhance how you plan, how you intervene, and how you provide outcomes measurement to your clients. And I think the reason why I use the word undermine is not, it's not that it's not being used, but it's, it should be used in this case, but they don't use it anyway. And I think there is so much potential with telehealth. And I think we can provide better services when we integrate technology in telehealth and in occupational therapy. I am for face-to-face, seeing the patients going out to the garden, going out, going to the community, helping them participate in occupations. I love that. That's what OTs. But let us not forget that we are in the 21st century and technology is inevitable. It's an inevitable element of our everyday living, and we need to be open to learning about it. It's not oh, I dunno how to use this new technology, or the gadget this expensive. I can just let the clients come into my clinic, to my cubicle and start the therapy right away. I think we need to be more open on how technology can enhance us, and how we can exploit technology. I wanna use the word exploit because, people are there are so many people, making money out of it in social media and all those things. But hey, as healthcare professionals, we are educated. We're supposed to be open-minded and hey, we're doing it for patients anyway. And I think there's also benefit when it comes to patient safety. For example, the patient is not feeling well or the patient cannot walk today or couldn't stand. There's pain. And you just need to monitor the patient. If he or she's doing well. A 15 minute telehealth would help and make that patient be like someone cares. And I think that could add up to the motivation of the patient to, okay, someone told me to, get up. And that really helps and I hope it can exploit technology to do that because it's not really about going through the assessment intervention and all that. It's really just the therapist telling, talking to the patient, communicating. Yeah. So that's the, that's for that point. I think too when you think about the potential of occupational deprivation, occupational pro apartheid or certain modes of sanctioning or thinking about the broader context that we now inhabit together, like you said in the 21st century the virtual context is a pervasive part of the international environment that we're navigating together and is having an impact on human occupation. And so we need to be understanding this context is a huge part of our client's lives. And I'm wondering cuz I noted that happy birthday recently too, right? I think you just commented that you turned 36 which is really awesome. So we have about three year age gap. So I'm a sympathetic to what you put forward as a fellow digital native. That has likely been a huge formative force, I would imagine in both our developments in going into our thirties, that it's hard to imagine a world not taking into account the virtual context. And to me, that what you're speaking to here of not properly leveraging it at this stage or not perceiving it in the US context, I see this huge broad gap of underserved adults, adolescents, teenagers, that, because in the US we, we don't have socialized healthcare. We most people that are young opt out of medical insurance we don't have a prioritization for social service investment in the United States. I know some of your work highlights addiction, which I think is so important for young adults in particular, and I think that to me, telehealth. is a likely a huge opportunity to engage in innovative models to try to service this population that I'm aware in the United States. I'm not sure about the Philippines that I think it behooves OTs to think about the virtual context and within os we often get this invitation to, to think beyond the medical model, to think about a social model of disability and to think about service delivery in different contexts that are less wedded to pathology. Do you think that telehealth can play an active role in some of those questions? Yes, definitely. I think I just wanted to add that the Philippines is an archipelago with so many islands and people need to ride boats and ships just to get to the center or the city and the United States and other countries like Australia and Canada. There's just so vast you need helicopters to get people from point to point B and they think that's where telehealth comes in. And your question, can you repeat your question again? last one, you were saying this to me. I think the lack of utilization of telehealth links to the. Systematic under servicing of young adults, adolescents, and teens, because it's not as hoarded by the medical model. And that is the demographic that I think could be the most responsive to virtual services as like digital native. Yeah. And I think it's something that we have to think about, and to me that str like a structural barrier because if you're working with young kids and older adults, both those demographics don't have open free autonomous access necessarily to technological services. certainly many older adults now do likely to credit from the pandemic. I know many did have to face their spheres of anx of technology. Yeah. I think as millennials and Gen X start to age, incorporating technology really should be part of our practice. That, that's where I'm spinning a majority of my free time personally is in some sort of context. Yeah. Yeah. I got now your question. I think telehealth is one way of providing services to young adults undergoing mental health or addiction concerns. And even people with experiencing disruption in their occupation. I think more than the telehealth is really going back to group therapy. I think occupational therapy historically have been doing OT in groups as it provides organic way of being belonging. And I think that sometimes the thing that we forget that we're so individualized and we, and because of the popularity of individualistic care or patient-centered care, we're not gonna go there but patient-centered care is a concept that really engenders individual choices. And that's fine for certain cultures, but I have been introduced to social occupational therapy, which originated in Brazil and the way they do OT there is so different from the America, from North America or in other cause occupational therapy in Brazil for those who are listening are funded by the social welfare services and not the medical and healthcare services. So the OTs there work in the social services and the way they do it, because I was, I asked OT from Brazil who's actually promoting that in the W F O T Paris Conference, and they did. A social OT session with the French OTs and I was able to go observe un wapping and they were working with people, refugees from Syria, Afghanistan from Africa, and in France or in Europe. And you know what they did? These people are, we can say they were displaced and they're reintegrated society. And it was so amazing for me because I just feel that's ot because they just did a picnic inside the river and the OTs were just, and creating conversations like normal conversations like what you do on a picnic. And they were slicing cheese and they were passing around grapes and fruits and red, they were trying to break bread and just share with others. And then people from different countries, like the guys from North Africa were playing music from Africa and they were just enjoying the time together. And when I asked the OT was who was facilitating that group session, ask, when do we start the therapy session? They say we start any time and when do we end? And they said we end when it ends. And that's also amazing, group therapy in these kinds of PO specialized population that do not necessarily need medical help or do not necessarily need some medicine because there's a pathology that needs to be done. But if it's a social pathology, there's a societal issue why people are displaced. And hospitals can't do that. Occupational therapist can help one way or another. And aside from telehealth, like again, just to summarize aside from telehealth, we can go back and introduce reintroduce group therapies because that can actually decongest the line, the cues in OT clinics, when we do group therapies together. And I think that's fun. That's why OTs are OTs, and I, yeah. Josephine. Yeah. To me, I take some of that challenge too in getting exposed to occupational science and thinking about occupational deprivation and ways in which I think it's so empowering to consider. Different forms and imagine new realities or old school realities for OT beyond the medical model. And part of me also takes it as a challenge for an OT that does work in the context of the medical system that all my clients that are pathologized, that have medical needs where they can't fully develop and grow without that systemic support being a touchpoint in OT in these systems where those occupational needs will otherwise be systematically neglected. And I'm seeing in what you were reflecting there too, a great full circle point about the cost of managerialism, right? That y you're taking something that could have maybe be a context where some of this really beautiful work can unfold of humans learning to be in co-occur with each other. And when you micromanage it externally and you make the goal these kind of abstract bottom lines where you end up, I think too when we deliver services that way, we miss. Having a reflective mindset of seeing what's actually causing the hospital readmissions. Sometimes those choices, I think they end up increasing those risks, but you don't notice it because you think you're saving money in one place and it's costing more in another. And I think it's important to catch that. But I personally believe that there are ways that I think OTs, even in more medicalized system, can create little micro chasms where what you express could actually unfold in more medicalized systems that are more sterile, but you still have humans in them that have occupational needs that need to express that have, that instinct. So I, I personally embed a lot of play in my work and looking at skilled nursing facilities that emphasize groups more. You could also take that as an opportunity with what you're saying and start implementing more of these social humanizing parts. So that's what I hope to share with you guys too, that are maybe interacting with occupational science for the first time. Once you know this language and you see what other OTs and occupational scientists have been able to innovate and create and fertile soil all over the world, my hope is that it's inspiring to you wherever you practice, that you can start. Kind of adopting more of an occupational lens. and I'm sure something you've engaged with a lot Mike too, is that the fact that occupation isn't always a construct that translates across different cultures. but at the same time just engaging in the conversation and making space for something new to unfold. These structures too that, we've started talking about managerialism it's honestly starting to fall apart too, because our healthcare systems, I wonder in the Philippines, are there places now that you're struggling to, retain staff? A lot of places in the US like where we're understaffed chronically in all these systems, and that creates, a void, but it also maybe creates some opportunity to innovate and think differently, like with incorporating telehealth more, for example. Yeah. I think the fallout of OTs in particular there are many reasons to that. There's the. The concept of massive quitting I think that's happening in the US or in other countries. It's because of the pandemic and people do not wanna work in the hospitals anymore because of the fear of getting, of contracting covid and all those things. And of course, with the unearthing of how healthcare workers are being treated during the Covid pandemic, you've seen news about that and how, and people are now being discouraged to get into the, into that kind of career or an industry. And I think one another way of we're also having staff concerns at the moment because many are flying to Australia, to the UK and to the United States. And we're producing OTs from the OT schools, but it's not enough. And after two or three years, they also leave. So there's just this pressure of churning graduates just to make sure that we have, not even enough, but we have OTs to, to call on in case. Yeah, it's the managerialism that you're saying. Of course we need to take that concept with a grain of salt. There's also advantages in that there's, of course, the reason why it's there is because it provides sys sustain. Oh, yeah. Yes. And it provides measurement in, in things and audits things accreditation and quality. But we also need to look at the other side of it just to make sure that we don't lose the authentic care that we want to provide our patients. Because our patients know if we are authentic or not, or we're just doing it like, as a repetitive task. And I think that's something that I'm very proud of as a Filipino ot because that is something that we learn in OT school here, that it's not enough that you have the skills you need to have the heart to serve. And yeah, because I think that's something that I'm really proud of because Filipino health workers around the world are known for how they really care for their patients. Oh, definitely. And I think especially I think I've had the, I've been very fortunate to work with colleagues from many different nations all over the world. Including and not limited to from the Philippines. And it's been such an asset to have the warmth and practicality and just generosity of spirit for so we're definitely richer from that and at the same time need to be an international, so solidarity so that you guys can also retain and have be the, having your communities, receive the blessing of supporting those students to gain those skills. Yeah. And I think too, from what you were saying, and this ties into one of your other points about occupation focused services and I was curious about, when we think about burnout and we think about possibly being connected to exploitative, more capitalistic ways of disseminating human services, I think one of the benefits that having an occupational science lens has had for me is this idea of trying to understand yourself as an occupational being, and to think about if your work is not having meaning and purpose and fulfillment. Sometimes people think that what they need is to be paid more, but part of what they're lasting after and craving it's almost like when you're craving sugar and carbs and those things, that's gonna feel good, but you might actually be craving something more spiritually in your work environment where your work needs to be more meaningful. And so those are other things that I think we can gain from having an occupational lens or occupation focused service. In your fourth point, you mentioned that perhaps in the Philippines, they're also struggling to provide occupation, focus, occupation centered type services. Do you think that in some ways viewing ourselves as OTs, as occupational beings that need meaning purpose, community connection how do you think what can you speak to what you were thinking about in your fourth point about having those before? And then do you think that infusing our practices with more meaningful, authentic care? Could also maybe address some of this burnout as we go into 2023. Yeah. Yeah I just wanna first go to the burnout concept that you've, you introduced. Yeah. OTs will be burnt out. I I experienced burnout out myself. I think we need to be aware that our job is difficult. OTs job is not an easy job. We deal with different kinds of people with different kinds of behaviors, different needs, and it's already stressful in itself. Not to mention the documentation and all those other stuff. So we need to be aware of that first. And the second thing is OTs, and that we are expected to be expert in occupations before we can even help and serve others through occupational therapy. We should al, we should first claim that we're able to participate in occupations, just to make sure that we're still in our, we are still centered in our own compass occupation includes rest, occupations include sleep, socialization, self care and all the other occupations that you can think of. Make sure that you're able to do it yourself first. Because you cannot be the best that you are and you'll just end up burning out if you yourself couldn't do self-care on your own. You couldn't tidy up your room because you're so busy with work and et cetera. So I think bef to, just to avoid burnout I want to remind OTs around the world that e ESR work is hard and there's bills to be paid and all that, but we need to take care of ourselves first. That's number one. And yeah. Cause it, and use occupations to take care of ourselves. Yeah. And having that sense of cause I, what I was surprised when I, so I guess I didn't, we got to talk a little bit on social media before here I got reintroduced to occupational science as part of my post-professional online occupational therapy doctorate degree through the University of Utah. And it, I'd been practicing in the field at that point for about five or six years. I'm going to my seventh year now. And it hadn't come up. This notion of occupational balance and Like this idea of seeing your life. So what's helped me personally is I studied evolutionary biology and evolutionary theory in my undergrad degree before becoming an ot. And the way that it snaps together in my mind is when we're trying to understand a creature in the wild, you really try to understand that creature in context. And in order to understand that creature, you gotta know what are they eating? where are they living? where are they hiding? When do they sleep and what time do they do this? And where are their mates living? And are they going over here this season? Or where are they in this one? It's really natural to think about animals that way as part of fundamentally trying to understand their biology. You have to know their habitat. You have to know what they do for sleep, what they do with this. But for some reason, even though most of us concede that humans are probably animals, we don't think of them that way. We don't think that we're ecosystem, that we aren't part of a habitat and that we don't, we have these things. And so I guess that's part of a, an invitation with all of you that are learning about occupational science for the first time. Yeah. You get permission to see yourself this way. And it's so important to see yourself this way as part of a collective, a part of an environment, a multi-generational environment that your sleep matters, all these things. And what I love about having occupational lens, that even if I just have 15 minutes with someone, I still have permission to connect with them authentically. Yeah. Like you're saying as an occupational being. they're, the fact that they didn't get sleep last night matters. the fact that they have a toddler that has matters. And that might impact how they grew, what their grooving and hygiene routine was that day. Often, I would say in the US our services are very granular, they're very dis personalized. They focus on some of the smallest details that are almost to the point of being meaningless to the occupational existence of our clients. And systematize them that way in a way that's it's this weird paradox. It's like the most unup thing is how occupational So when you, so I'll, if you don't mind, I'm gonna read what you wrote aloud. So it's unfortunate this is in my science voice, that our services are not largely occupation focused. While Okay. And helpful. We can see a lot of webinars and trainings focus on certain techniques rather than how we can promote participation engagement, access to health occupations for people, community and populations. Sadly, most of these popular techniques don't even mention occupations. And a blind glorification of techniques will not help in claiming our professional autonomy in the future. Ah, I really connect with what you said here, even from a US standpoint. And I'm curious too, do you find that in the Philippines there's also a struggle, struggle to utilize an occupational lens and to see the humanness in these systems? Is it really routinized like you're saying, or very focused on just small biomechanical bits and. Yes. I think we have been under the Medi me medical profession for the longest time, and it was very, it was a struggle for us to get out of being shadowed under the medical session for some years. But in 20 20 19, 20 20, we already have our OT law. So there's an OT law, which separated from physical rehabilitation. And that's already a big step, but it was a 30 year, struggle just to, to make sure that we have amended, made sure that we have our laws, and that's already the, a good step. But it's, we have to do a lot more things because yeah, as funding is related to medicine. Staffing is related to are you going to be staffed in a hospital? If yes, then you're gonna get benefits. But if you're gonna staffed elsewhere, which is not a medical or ho or a health institution, then you will not get as much. So there's always this desire or the need to focus on techniques. When you say techniques, these are protocolized approaches wherein we have steps 1, 2, 3, 4, we need to do this. 1, 2, 3, 4. And when OTs do that, then you'll you will gain approval from this biomedical system. And we, and I have observed that a lot of webinars and trainings still are still very focused on, on techniques. And I am not saying that they are bad or they're not useful. They are useful, but as an adjunct or as a preparatory activity, and a preparatory activity is not necessarily participation, it doesn't necessarily lead to participation. And OT needs to connect that the from preparatory and making sure that eventually that person knows why he's doing that preparatory activity in order for that person to participate or not just a person, but a group of people to participate. So I think many OTs are being driven into going into, do into these webinars and trainings because it sounds medical. So because OT is under the shadows of the medical profession, then I think this is. It will give me more approval of my certification and my qualification, but we fail to forget most of the time that the reason why you're called an occupational therapist is because you're supposed to use the power of occupation to serve your, not necessarily clients and patients, because sometimes we serve people without illness. They just have issues on participation. And that's why I wanted to use, and I learned from the people who commented in my Facebook, it's always a learning experience when people comment OT should start also using the word people or prison because that person does not, is not necessarily a patient or they didn't get admitted into a hospital or a clinic, but they have issues in participating. I don't, I have low vision. I couldn't I have a new workplace arrangement and I just couldn't work and I need help with my desk. These are potential people that can benefit from occupational therapy and I think the blind glorification of these techniques will really divert us or put us out of. Goal of being an autonomy, but also a partner of other professions? Yeah, distinct perspective. Personally, especially now that I've gotten to connect more with the legacy of occupational science and thinking about, differently about what it means to be a science-based profession. So many people it takes in a face value, a more modernist philosophy perspective where what some, something is scientific, when it's standardized, when it's latinized, when it's, isolated into little tiny parts and that more reductionistic model. But there are different ways to think of science, where science can be more of a process of understanding and a process of inquiry and being really understanding the humanity and the person's context, their occupational context as the foreground. Sometimes I've noticed when our services aren't occupation focused, occupation center, They we can really easily pre decide what sort of interventions that we'll utilize without understanding the the occupational barriers and what is happening in the context of our client's life. And if you're not connecting your intervention with the life process of whatever system or client base you're working in there's almost no way that we can also be sure that our services are effective at creating tangible, constructive change for our clients. Cuz if we walk in and we just assume that everybody that has a diagno diagnosis with autism needs a specific sensory protocol. You could be wildly out of blue, the left field and potentially it almost, to me it's a big problem to not be oriented to practice that's very responsive to what our clients are telling us that they need. And not starting with a listening ear cuz there's actually a risk that you could cause harm by not really being engaged or in touch. And that I think is something distinct that we have the invitation offered as OTPs. wherever we're practicing. The fact that sorry for this tangent in a way, but one of the things I love about o occupational science is that it has a healthy. Sense of value for the social sciences and what the humanities have to offer even in a medical context. And I think that if OTs got the confidence to really center occupation as part of their practice and getting more acquainted with the body of work within occupational science, for example, you will know that you have something special to offer that you might not easily see from a physical therapist, from a social worker, from a psychologist, and from your allied health professionals. We have a really robust foundation in the social sciences and other ways of knowing that can really be, in my experience, very welcome and very needed. A lot of our clients that I work with, when you start with an occupation focused approach, they often feel heard and understood in a very deep way that a huge fan of occupational therapy when you can really show up for them in that way. Yeah. Just wanted to add add to that because I was talking with my colleagues from Brazil and from different countries. We were working on an abstract for the Occupational Science Europe conference in Denmark this year. So we had a conversation, and one of the things that we are OTs are stereotypically perceived by other professions as very complicated beings. We always want to reflect and take a look at all sides and angles. And I think sometimes it feels oh, are you trying to say that? It's something negative or something bad. But actually we, when we had this discussion with my occupational scientists colleagues, is that occupation is supposed to be complex It's not simple. And I think we need, OTs need to realize and be aware that it will ot an occupation like making coffee for a person with free rheumatoid arthritis, for example. It's gonna be complex and. And OT needs to have a complex way of thinking in order for them to understand how that person could eventually make coffee and enjoy his or her bread in the morning while reading the newspaper on an iPad. I think. The, because sometimes OTs think that, oh, we're here because we need to simplify things for people and sometimes that can be misconstrued to, oh, you just order an assistive check, give it to the patient and that patient will have an easier life. No, we also need to think complexity that occupations are complex and the reason why we studied activity analysis and occupational analysis and the reason why we look into all the elements, like how big the spoon would be or the fork or like what kind of knife you're gonna use, the handles and everything is because we're supposed to really provide and understand the complexity that people with injuries, with disabilities experience, even though we. Share that lived experience with them. And that's the beauty of occupational therapy. Friends from the physios and speech therapy and our friends from the other professions would always think us we're always like, we always process and all that. Yeah. But that's how it is. That's how we are. And yeah. That ing personally, and one of the reasons I was excited to have you on this podcast, and especially for the first one is I initially got introduced to your name in citing the podcast you did with OT and Schill. And there was a notion of a conversation of, really everyone could be an occupational scientist. And personally, I think when occupational therapy is delivered in a way that is occupation centered, occupation focused, and that you, there's almost no way to avoid if you're gonna do it. in a way that's really mindful to this process. You're almost doing occupational science in lifetime because you don't really know about the occupational reality of the client you're working with, whether that's a person, a group, a population, unless you start with listening and understanding with a sense of really appreciating how they understand their own context. And to what extent, what do they want simplified, and sometimes we actually need to make things more complicated. For example, I have a D H D, so there are certain things I need to be made simple and there are other things I need to make more complicated so that I'm motivated to keep pushing forward. Yeah. And the way that you adapt something that would actually enhance my health, my wellbeing, my participation. It's it's a lifetime scientific process, which isn't science in a way of that. We've produced a randomized controlled trial and we got a really robust sample size that determined that this variable can have a linear causal effect on this variable. Under these certain circumstances we're actually, in my mind, the way I frame it is a lot of OT can be like field biology as opposed to experimental biology. We're testing a lot of hypotheses in live time. Yep. Collaboratively with our clients. In the context that they naturally inhabit to see what actually functions and sustains within their life. Just like you would work with an animal that injured their leg in the wild and they came in and they got, wildlife rehabilitation, you would set them up to succeed in their actual habitat. You wouldn't all of a sudden transplant them in a different part of the town and city or put'em underwater, if it's a fit, you have to understand these things. So I personally feel I want all occupational therapists, including occupational send therapy assistance to know that when they're engaging with the like in the us, the O T P F four domain in process, when you're following a process, That's scientific. You are a scientist when you are working collaboratively with your clients to find an adaptation that's really gonna work with them. And what I love about what you're framing too, in really claiming the complexity of occupation and our interventions when it's done well is I often find in the US you almost get gaslit systematically. And I think some of it is systemic sexism where they assume that anything that's caretaking is simple, is not reimbursable, it's invisible. It's something that doesn't require a skilled provider to facilitate what I find is a lot of other allied health professions assume that what occupational therapy do therapists do is simple. For example, what I find with us not being very occupation focused in the United States, we've actually seeded a lot of our territory and post-acute to physical therapy, have found more confidence in a holistic model of care delivery. And OTs I think, have been timid about more holistic, occupation focused work, not being viewed as skilled. And we've let other professions feel confident taking up that skilled space. So I'm with you and I think that there's so much benefit in owning the complexity of occupation. and then leveraging that too and showing, yeah, really not everyone can do the work that we can do. that is our skill. That is what we bring to the table. And it's not a technique, it's a process. Yeah. And it's scientific in lifetime. I don't know how many occupational the scientists or therapists would be open to that, but to me, I personally think it is a truly I think it is a science when we do things that way. So thank you for your time in this. You have one last point to reflect upon. So this one, I might need your help understanding the Philippines context. Uhhuh. So it says there's no fee regulation among occupational therapists. Each center institution has its own policy, depending on geographic area. While we're aware of inflation and the loss of garnered due to the lockdowns, our fees are becoming inaccessible to many Filipinos. I have been told that some fresh graduates even asked for higher s what is PF professional fees? Okay. Professional peers with a decade of experience in home healthcare. They also are told how group therapies are becoming trends where OTs get higher pay by putting clients together without shared goals. Some clinic owners who are OTs even shared with me that some OTs are more money than service oriented without regulation in a system of pay scales, including incentives and anoc, occupational therapists in the Philippines will make it more difficult to keep them here to serve. Perfect. So this is, I think, also really good con conversations to have in the US context, but maybe you can speak a little bit about how this is impacting OTs and clients in the Philippines. Yes. I think the reason why I posted this is because I had conversations with OTs who are actively practicing in the clinics. And I've been in the academia for more than five years now, and sometimes I need to touch base with practitioners, clinicians, like, how is it, how, what's happening? How much are you get paid now, et cetera. Because in the academia you get paid differently. There's a different scale for that. The thing with OTs here being privatized rather than under the universal healthcare there is a, what do you call a standard pay, but it differs depending on the city, depending on where it is. And. There's also no regulation when it comes to pay scale or how much you would how much money you'd ask for a patient for certainty. And as we know, inflation is rising everywhere in the world, I think even in the United States because of what has happened last year. And the thing that I'm trying to reflect is with inflation and all this rising fees for OTs without regulation, it's OT becoming an injustice to people. So that's what I'm thinking. Like we cannot access OT because it's too expensive. It's only for, it can only be afforded by people from the middle and upper class because we have different classes here. And it's not like Europe wherein you have a more homogenous social strata of people. But I don't know, in the United States, maybe we're seeing more gap between the rich and the poor. Here we, we know that, and I am thinking that yes, occupational therapy is trying to promote occupational justice and all that. That was my, that is my research and my problem is OT itself is becoming an injustice to many people. And that really made me think. Equity disparity and all that. And when you say about, because of the, because we have no regulations, the fresh graduates or the, the entry level graduates would sometimes ask for more pay because they don't have any guideline on how much they can ask. Or they can just tell patients, you need to pay me this because I have a, no, I have an OT license. That's okay. But sometimes, it could be conflicting with the seniors who've been there in the field for so many years and have so much experience. And yet, and there's this, there's a problem with the fees. And also I mentioned about group therapies, and this is an ethical issue because I've heard that there are some OTs just to, because patients pay per hour. So if you put five patients together, that will be times five of your pay per hour. And there's nothing wrong with that for as long as you have shared goals and they have, they present certain issues and you are using an intervention that would target all of the, of their shared issues. But that's not always the case because of. Money orientation rather than service orientation. And it's a very complex, wicked problem that we're experiencing here. Huh. And again, without regulation in a system, then I don't know how we can keep more OTs to stay because some OTs are becoming frustrated about the system and that is always an impetus for them to decide to leave and go to other countries. That makes a lot of sense. And I think these are questions, these complex questions that, obviously they intersect with economics and our quality of life as occupational beings. And then you also added in the notion of occupational justice issues. Yep. And to what extent all, these questions that you're bringing up here have so many points where we need to be reflecting and we need to be I personally and I wouldn't say that I have any settled personal responses to these problems other than needing to sit with them is personally I'm more for a diversity of different formats and models of delivery of occupational therapy and experimenting. And I think that we almost, I think we need to be researching lots of different service delivery models across diverse cultural contexts. As we are reflecting on kind of the social model in Brazil, for example, that I think Yeah. Likely, I can't imagine a cultural context that maybe can't learn from their example in some way. But when I was reflecting on what you put here in the United States context we have, I guess a little bit of both going on because we are, we are included among, Medicare services for, particularly the post-acute option. And some of the challenges that we face with work-life balance and burnout and managerialism relate to that. Whenever Medicare reduces their fee schedule and reimbursement for ot, there's a, on one hand, our services are maybe technically becoming more accessible to a brighter diversity of the general public, and at the same time, it's driving down those quality of life wages. And we definitely in the US have an issue with a more privatized healthcare system, where we do tend to court and we tend to study the needs of middle and upper class populations to the detriment of really the clients that probably need us the most, which are systematically not allowed to earn a income in the United States, most young adults with disabilities. When I see the United States, I just see so much neglect. Of the clients that really could benefit from having OT allies the most. And yet there's systematically just no way to access our services. So I think we have to think really creatively about how to actually open doors to the impact that we can make. On one hand we wanna make our services, I think, more economically accessible to a broader diversity and cohort of folks. Obviously I think leveraging technology in many different mediums of having a tangible impact on people's lives. And on one hand, I think it's good if you can utilize things like groups or online mediums in different ways. Personally, I'm really inspired at thinking about hybrid having diverse revenues, streams of revenue, rather than like only looking at one way, which in the United States, we now have the Occupational practice framework, fourth edition that opens up the virtual domain. It looks at Yep. Populations, groups, and more of a social model. In one way, I think that entrepreneurialism is an important vehicle to start examining and studying ans potential answers to these questions. which unfortunately would also create more of the same challenges that you're seeing here, because there would then be a great diversity in disparity between and across OTs rather than standardizing our fee. Yeah. Yes. I agree with providing diverse services and options and hybridizing different ways on how we can serve our clients. And I think there's this, there's still this fixation of we serve our clients when we see them, but actually it doesn't have to be like that all the time. There are clients that you just provide a home program or a program that they can they can use on their own and do on their own. And that in itself is occupational therapy because if that program, whether you see them every week or not, is helping that person participate in different occupations. And you have a way to look if, or monitor if that person is really participating. And if you're trying to help that person achieve their goal then that's occupational therapy. I think we need to be open with different ways of doing things. And of course we will also need to go back to the traditions of OT and let's not forget, I am progressive in a way, but I always need to remind myself that we need to go back to traditions. We need to go back to history. We need to go back to. Conservative ways of thinking, revisit them so that it can always inform the progress that you want to have. And you want to think of, because I don't wanna be progressive and be blinded with what happened in the history, because I love history myself, and we need to understand first where this process came from, where this came from. It's problematic. This approach is problematic, but we need to always go back to the history as to why did it even why was it even established? And I think to be progressive, we need to look to always revisit and look back and just to balance our arguments, our approach. And I think looking back into history, looking back and looking at the other side of the spectrum you might wanna believe this is your opinion, but you also need to listen to others' opinions in order for you to be more confident in what you're saying. And because there's always this issue with, with social media and Twitter, like you have an opinion and, in, in Twitter There are some OTs who are just, clashing and that's okay. And the way we need to always look at all the sides as, as much as possible so that you can be more confident with your arguments and the way you think. And I think that's what I'm learning at the moment. Yeah. And I like history so yeah. So I'm progressive, but I'm also, I'm not saying that we should not look at the conservative way of thinking why people are being conservative, uncertain. Aspect. Yeah. Yeah. I think ERA is in, I imagine where you were saying that you got your OS education in Japan and I, I'm obviously more western informed. So like I'm familiar with Dr. Michael Alma's work, for example, which I think has of course been, I've heard him speak recently too, about that wasn't necessarily, embraced all together within the Japanese context in and of itself. But I, I love some of Dr. Alma's reflections on the value of relativism and how much we do need to have space for. I think the era has fully been transcended that there isn't gonna be just one right answer to these questions, and that we do need to make space for a diversity of perspectives and collaboration towards, often we have shared goals, but different ways to go about obtaining them and Part of this question, like you're saying, it's so complex that we're likely going to have to meet it and study it from a diversity of different standpoints and maybe be open to new models that maybe haven't existed yet. One of my goals with this podcast if I can be effective at ex exposing more OTs and other members of general public and allied health professions to occupational science and the perspective that offers, I would love for OTs in the United States and elsewhere to get inspired by OTs internationally. I think that there are so many really cool models, different ways that OT has been able to grow and develop historically and contemporary and all these different cultural contexts that I think we should give ourselves permission to be inspired and to have conversations across difference and make space for OT to keep changing, to keep developing because humans keep changing and we keep developing and our context around us aren't changing anytime soon. I think part of being scientifically accountable is to acknowledge. The existence potentially of entropy that not only are things complex, they're gonna keep getting more complex. Yeah. And so we need to actually support each other, give each other some grace, and understand that there aren't gonna be hard and fast answers to a lot of these questions as much as we wanna oversimplify them. I think when we oversimplify complex things, we actually just make them more complicated and more messy. we can be honest about it. And I know that we're coming up on the end of your time too, and I love some of your reflections that you had for occupational therapists as some like action items and thinking about the new year. And maybe if you're open to it, we can end the conversation with some good well wishes of resolutions that we can have for us as occupational therapists. The first one that you wrote was to refocus services on occupations and environmental modifications. Do you wanna speak a little bit to that? Yeah sure. I think we already talked about the problem of how OTs are trying to forget most of the time content the, yeah. And focus on techniques and forget about occupation. But I'm happy that more OTs are becoming more aware and I think we need to refocus the way we deliver services. I am okay with using preparatory or. Activities or modalities. But let's make sure that the means and the ends would still be occupations and environments. And not forget environments. When you say environments, it's not just a physical environment, but the social, the virtual cultural political environments that we need to be aware of so we can modify as much as we can. Perfect. And you also said to use lived experiences and not only evidence to guide goals in ot. Yes. About this one. There is uh, in the past decade and when I was still in OTI school, there is always an obsession with evidence-based practice. And yes, it's good. I am a scientist myself. I use a lot of evidence when I do research and I love it. But when we deal with people, when we work with humans, we need to consider their lived experiences as the evidence of why they're living. And so we need to use these lived experiences to guide us in our OT goals. And I think sometimes we just forget that because we're so focused on the range of motion and the measure of this and that the measure of perceptions and all that. But we forget that lived experiences are equally important. Aside from just using evidence to guide us in our practice. Yeah. Cause then you're kinda at risk of imposing, those solutions are assuming that it's gonna be the right fix and it really should be a conversation and adapting evidence too, for that context. Perfect. And to community clients using ordinary language and not only in English. So Yeah. Bringing that authenticity in. Yes. Yes. Because just to, to comment on that English is one of our official languages here in the Philippines. And I think in other countries in the world there English has be, become has become a primary or secondary language. That's good. And because English is an international language, when we talk with clients, when we talk with ordinary people, they would appreciate it if you use the vernacular or the ordinary language that they use at home. Because that's because we don't want to be intimidating in front of our clients. We want them to feel that we relate, we resonate with them and we wanna help them. And ordinary language. And when you say ordinary language, I'm not saying just verbal. You can use write written language, you can use gestures, ordinary language. I think this is so important for all healthcare professionals and OT in particular to be a leader. Cuz so much of our cl, so many of our clients don't express language in a conventional and accepted way. And I think we have to really adapt to those circumstances and make space for so many different ways, especially as our full client base becomes more international too, that, we need to be open to diverse forms of communicating. And so I really appreciate this reflection. I think this is such a good, I hope that OTs take note of some of these resolutions from all over all over the world. And how about to be critical enough as not to reinforce ableist and illness oriented practices? Yes. I don't wanna elaborate so much on this because this is quite a very just an article about this con controversial and complex con concept. But there's an article on this, we wrote about it, it it's entitled, it's OT Ableist Health Profession. So you can grab a copy. It's open access anyway, but just to, yes, it's open access. So you can go to the Brazilian Journal of OT and you can find it there. I just wanted maybe to comment on just not to impose like what you said, we cannot just impose that. Because some we are, we tend to create goals like the. Should be able to do this and that. And sometimes we need to be mindful that even if the client or the people that we're working with is not able to do this yet incremental changes or incremental improvements are still participation. I think we need to be more aware of that and focus on how not on illness really, because people, for example, with cancer, they are ill, we already know that, but let us start recognizing what they can do and what they want to do at the moment while there's what with the remaining days or weeks of their lives. And I think we should focus on, on, on participation really and occupation so that we go, we all go back to demeaning and value of life for these people and not really you're, you don't have cancer anymore, or you don't have an injury anymore. Let's go back and revisit and be critical in using these terms. What I'm hearing from you too, which I think is in spirit with so much of our conversation this, for me, it's this evening. For you, it's this mid afternoon, is that authenticity and being putting human beings first and really centering human rights as part of your practice as an occupational being. One of the things I love about occupational science is it prompts me since part of the conversation, you're allowed to view occupation in the basic science. This is now just how I understand other human beings as a citizen of the world. And, if you wanna connect with others respectfully and honor their humanity and their wishes for themselves, this is another, paired human being. I think if you can center that in your practice, it becomes actually easy to get out of a potentially ableist track or falling into some of the logic of these systemic patterns that have us reproducing imbalance. And this is just a great invitation for, I think for all of us to get more exposure to disability studies and listening to the disability rights movement and all over the globe. So I love this other reflection about being sensitive to context, ensure clients' voices are heard and enacted. So beautiful. Yep. Participation, partici, participatory approaches. We need that, we need more of that Yes. And I think that is actually, it's so simple and yet it's actually challenging to implement that in so many of our settings that I noticed here in the United States. I've been pushing for this in my own post-acute care where highlighting that my goal for a restorative program is not so much with a range of motion in that they get the right after they come after services. Just today I was talking to my manager about how I would like, Our sessions to think about more in school-based practice, conventionally in the United States, you look at access and participation with quote unquote age level peers and you support the teacher and the community to adapt activities so that students with disabilities and differences are enabled to participate in a way that's empowering and meaningful for them. And in my mind, I think the skill of OT could also be used that way in a post-acute setting where if they can't access the group activities that everyone else is doing, it sometimes takes the skill of an OT to adapt and create materials that enables that person to participate. It still a hard sell cause I'm pushing a social model and a medical model, but I'm working towards it. Yep. So I love that reflection. And sorry, your last one is to be conscientious that our client is our service user and not our customer. Yeah. I would like to give some corrections on this. I was I had a conversation with colleagues about the use of service user is being used in the UK context as as someone who would be Given a service from the health healthcare system. So they, I agree with them that we might wanna use the word people. Our client are people, they are persons that have needs, and they're not just customers just to try to go away a bit from the neoliberal and capitalist ways of thinking, because sometimes when they see them as our customer, like we're serving them and all there's a, there's always a power struggle rather than a caring struggle. And I think we always need to be mindful of this that yes, we are being paid to do what we do, sots, but we're there to provide service to them and help them hopefully more than just the money that we get or we need to get paid. I'm for that we need to get paid with our. But let's not forget the caring part. The caring, the supporting, the partnering part. As an ot, the state of the humanity is part of the process. I know one of the ways that bugs me continually when we get these things mixed up and we get so enmeshed with a, like the forces of capitalism too. One of the things I notice a lot with other US-based OTs is that they will say something is unethical when it's not in the entrance of the insurance company. So they'll say, we can't do that because that's unethical. But really that was just something the insurance company said that we don't wanna pay for that. And I, its very dangerous when we conflate ethics with what's in the financial interest of one party or the other. Yep. When really you actually need to separate ethics from the financial exchange and make sure it's aligned how. Anyway, I just, I appreciate that reflection. So Mike, I'm so sorry that this has gone so much longer than No worries. No worries. But I do think the spirit of inviting you on this is just, I think how much we have to support and to learn from our international peers. And I think it's so important that we start to bring some of these conversations into the broader, I guess the broader sphere, not many people do travel internationally to go to occupational science conferences or many OTPs are not gonna choose to go back to school. They deserve, I though, I think to know that these conversations are happening and that there are cultural contexts where OTs are empowering themselves and getting themselves permissions to be human centered and to think about different ways that we can start developing our practice to be more equitable and more responsive, and honoring the complexity of occupation and how that's complex for every single human being on this planet and know one human being is more important than another human being. And so we do need to appreciate each other and be in international solidarity with each other and we can add so much to each other's lives. I think I want others to feel inspired to check out Mike's work. He has really amazing publishing about, I know you have done somebody work around beauty pageants and that is a huge thing in United States as well, And I love occupational science work that kind of piggybacks off of. Things that are not shocking in the OT world. Like for example, grooming, hygiene, daily care, self-care routines. I really think that having occupational science that looks at the occupation of beauty and how that impacts, and you look at the dark side of the beauty compo composite. When I got to get exposed to your work, I was seeing how much that plays out with the clients that I work with on a regular basis. And so I think that even though your work is really focused on the Philippines context, we have so much to learn from it across you, across the world. We really should be inspired by the in science that's taking place. So some of my resolutions this year, for OT is I would love for all OTs to consider embracing occupational science and a bio psychosocial lens in all settings. I personally think that, all of these things are blended and they're part of occupational identities. So I'm hoping to encourage conversation where more OTs feel empowered in that space. I want to encourage more reflective practice. I want us to start envisioning a more creative future and create space for conversations like this to happen outside of formal exclusive settings like academic institutions state and federal conferences and whatnot. So thank you for supporting me and my resolutions and my goals by sharing your body of work. And I'm curious where would you invite people to connect with you and what sort of work do you think would be really good for new people that might be new to occupational science? Thank you very much, Joseph for just inviting me, and I really resonate with your purpose of providing an open. Conversations and exchange of knowledge for OTs who are interested or who could be interested in occupational science by just listening to a podcast and not necessarily having to go to a conference. And, that could be expensive for many OTs, but I can be seen on, on social media. I think you can post that in the in the podcast. I am recently going to be very active with the International Society for Occupational Science as I am. Designated as one of the board members of that group. And we will be having virtual events in the coming months throughout the year inviting occupational scientists from all over the world to speak and talk about occupations from their part of the world. So please be excited about that. So you can just follow us in in our social media, in ISOs I S O S, and of course my own personal social media. If you wanna learn more we can have more conversations with Justine and Very thank you for this opportunity. Thank you. We'll definitely be promoting those events. That's huge. I love to hear that. That's an opportunity. And I'll key off, and this will be in the description of the podcast, but if you wanna look up Mike size academic work, he has a full name of Michael, m i c h a e l s y. Super simple s y. And I did notice that some of your work was featured on Research Gate and that it sounds like there are some open access publications, which is fantastic. So I certainly encourage you to check out his work. I think you'll find it fascinating even from a United States context, or if you're based in Australia or Canada. Please check it out. And you can keep in touch. And Mike has already been an active member as per of the OS Empowered OT Facebook group. So check us out there and really get involved in the International Society of Occupational Science. I can't find a more welcoming group of people. Certainly the conversations can get fruitful. They can be, passionately divided in thought But to me that makes it a much more robust scientific discipline and a more welcoming one to diverse perspectives. So I hope you feel welcome. I hope you feel empowered, and I want to end this with just well wishes for you, Michael, and just all OTs. Thank you all over the world. I hope that 2023 can be a year full of great potentials and that we can take all this strife and challenge and barriers and structures that we've been living amongst, and find the inspiration to also see the potential that we have for learning from this, humanizing ourselves, humanizing our clients, and continuing to find paths forward for wellbeing, inclusion, and the things that make life matter the. You are important, and we get to be involved in a really empowering mode of inquiry and intervention. You're so lucky in this life to be an O T P and I hope you feel and take full advantage of what you have to offer this world. Thank you so much for joining in the first christened episode of this New Year. Thank you so much for joining.