The complexity of culture

The World Federation of Occupational Therapists (WFOT) recognises the increased awareness and focus of occupational therapists in culture and diversity. This is linked with the profession's person-centered approach to service delivery and a need for an inclusive society in which all persons benefit from equitable opportunities for participation. (WFOT Position Statement, 2010)

The word culture implies to me complexity. It includes the knowledge, beliefs, morals, law, customs, and habits of a group or groups of people. Culture is learned as a person is socialised into it, be it the culture of major national groups, the culture of marginalised groups, the culture of professional action … . And all groups are diverse.

About ten years ago, The World Federation of Occupational Therapists undertook a project to explore the issues of diversity and culture and subsequently published Diversity matters: Guiding Principles on Diversity and Culture (WFOT, 2010). The two lead authors of the document, Astrid Kinébanian and Marjan Stomph did a major literature review and then drew together 49 occupational therapists from 30 countries and 2 occupational therapy consumers considered to be experts on the subject. Through several iterations and more than five rounds of review, the final version of this document was agreed and approved by WFOT Council. The document includes reflective questions meant to stimulate discussion.

The group determined that the guiding principles in diversity and culture include:

• Human rights and inclusiveness matters: Occupation, participation for all. WFOT Position Statement on Human Rights: the right to participate in society. With the Reflective question: How is inclusiveness reflected in practice, education, professional association, and research?

• Language matters: The power of words which is the used professional language and jargon often results in exclusion. With the Reflective question: How do you ensure that inclusive language is used in public documents?

• Competence matters: Attitude, knowledge and skills. Competency is a continuous process rather than an end point, a journey of personal growth. With the Reflective questions: What are the main barriers to become cultural sensitive and competent? How can the principles and practices of cultural competence be shared? (Kinebanian & Stomph, 2010)

This significant document can be used to encourage dialogue and deliberation of

ways to appreciate and value diversity and differences in the life styles of people that occupational therapists serve all over the world … . Such consideration and discussion will facilitate acknowledgement and acceptance that cultural diversity is an area that enriches us professionally and personally. It will enable the profession to contribute to a more respectful and inclusive world. (Kinebanian & Stomph, 2010)

In this WFOT Bulletin on practice across cultures, a number of articles reflect the professions considerations on these issues.

Garcia-Ruiz and her colleagues note that reconciliation with people affected by civil conflict may be facilitated by the power of healing, both self-healing and collective healing through occupational therapy using silences, words, drawing and movement (Garcia-Ruis, Moreno, & Mojica, 2019). It is through overcoming the cultural divide created by conflict that reconciliation can take place.

Livet and Manuel compared the development and professional training of occupational therapists in Colombia, Mexico, and Ecuador. They relate the development to the macropolitical factors affecting the formation of the country and the profession (Livet & Manuel, 2019).

Burns notes the social exclusion and occupational injustice faced by disabled children and their families in Kyrgyzstan in Central Asia. She describes a parent group which has formed a resource center called Sunterra that promotes awareness about Down Syndrome, provides support for parents, and pilots related activity programs (Burns, Eshalieva, & Bakhshi, 2019).

As diversity and culture remain at the top of our agendas throughout the world, we can reflect on our own cultural competence in our occupational therapy practice, education and research through the resources available on the WFOT website (www.WFOT.org/resources).