Occupational Therapy is a Work-in-Progress

by Tsogt

Occupational Therapy is a Work-in-Progress

By, Ana-Maria Udrica
August 26, 2008 · ULAANBAATAR, Mongolia

“It is my wish to build a rehabilitation center where occupational therapists can work together with physical and speech therapists, as well as other specialists to help disabled people,” says Ulziimaa Natsag, a certified occupational therapist aid working at the Kindergarten and Nursing Complex # 10 in Ulaanbaatar.

No such center currently exists in this country and, whilst the fields of physical and speech therapy have developed, occupational therapy is still in its beginning stages.

As defined by the American Heritage Dictionary, occupational therapy refers to “the use of productive or creative activities in the treatment or rehabilitation of physically, cognitively, or emotionally disabled people.” It goes one step beyond physical therapy by not only increasing strength and muscle movement, but by doing so to help patients perform the daily activities with which they would normally occupy their time in the absence of conditions such as autism, cerebral palsy, downs syndrome, tuberculosis, polio and HIV/AIDS.

Although a limited version of occupational therapy emerged in the 1700s, it began as a profession in 1917 with the founding of what is now known as the American Occupational Therapy Association, Inc., in the United States. Knowledge of the field did not, however, reach Mongolia until years after the downfall of Communism (1990). As the country opened up, new ideas came in from the west.

According to Ulziima, in 1996, American volunteers came to train Mongolians and provided primary knowledge. “This stirred our interest in a very new field and encouraged us to improve our skills and, years later, the Japanese also came to help, giving practical knowledge and showing us how to treat patients.”

Prior to this, Ulziima, had graduated from Medical School in 1993, but had only heard her teacher randomly mention disabilities. Knowing she did not want to be a doctor, she was instantly curious, “I wanted to work with the disabled. Unlike others, I was not afraid.”

Ulziima attended all the conferences given in Mongolia by foreign experts and even traveled to Korea to learn more. “Training is very important” she says. “It is the only way we have to qualify.”

“We asked the Health Sciences Medical University of Mongolia for help and to provide the necessary equipment to enable us to study at their institute,” Ulziimaa recounts. The University responded to this request by allowing a volunteer Czech occupational therapy professor to come to Mongolia twice to hold classes. Since then, the Swiss Association “OT/PT Mongolia” project, founded in 2007, has been in the process of organizing an occupational therapy department and educational program through the University. Teachers are being sought and details about the program are being determined.

Further training and financial assistance to bring in outside help are not the only things needed; one must be certified in order to practice and help the field grow. It took the U.S. until the 1940s to create a training program and until the late 1980s and early 1990s for bachelor and advanced diplomas to be offered.

“In Mongolia we do not have a set system and the training we get from volunteers is unofficial. Therefore, we have asked medical organizations and the University to issue certificates allowing us to practice. The University has agreed and this has provided great opportunities for us to practice in the absence of bachelor or graduate degree programs.”

Occupational therapy is extremely new in Mongolia and the education and certification thereof is, therefore, still in the process of being drawn up. Once this has been finalized and consolidated, prospective practitioners will be able to obtain degrees authorizing them to practice or teach, if they choose to acquire additional teaching degrees.

“The jobs are here and nurses, doctors, those working in disability fields, kindergartens or neurological hospitals are interested,” Ulziimaa assured, “but we do not have sufficient qualified people to fill the positions.”

This increasing demand for occupational therapy comes from a heightened sense of awareness. “Ten years ago, not many had heard about this field - now more know.” As a result, doctors are turning to occupational therapy instead of the injections, medication, or electrotherapy that would have been considered and/or used before.

However, awareness is just one small step in bringing the issue to the forefront. Further action must be taken. In the U.S. it took the passing of the Education for All Handicapped Children Act (1975) to employ more occupational therapists and address the issue of discrimination. Similar impetus is needed in Mongolia because, right now, disabled persons encounter tremendous difficulties. For example, wheelchair accessibility is lacking in the countryside and city and people living in gers have a difficult time entering and exiting their homes.

Getting similar laws passed will, however, be difficult because major skepticism about this field still exists. For some, occupational therapy promotes the use of treatments too simple to be important. “You don’t always need medication and surgery, sometimes you only need simple things and a little heart to help people,” Ulziimaa affirmed. “The results are most effective when doctors and families cooperate with patients. Each second and minute they must work as a team to implement basic, repetitive exercises because, although simple, these are very valuable and have proved effective.”

Although overcoming these obstacles will be a challenge, organizations such as the Swiss Association and people like Ulziimaa, fighting for the chance to obtain qualification degrees in order to share their knowledge with the rest of Mongolian society, make progress only a matter of time.