"Culture greatly influences a person's beliefs about life and death, welfare, family relations, diet, and especially sickness and health care."1
As ethnic and cultural diversity continue to increase in the United States, it's essential that occupational therapists learn to communicate, understand, and respond to clients' values and beliefs that are embedded within cultures. To provide holistic treatment, healthcare providers must increase their cultural sensitivity and cultural awareness.
Cultural competence in professionals can be profoundly fostered through international service learning experiences.2 International service learning should be considered an integral component for educational and professional training in occupational therapy programs to enable optimal client-centered practice.
Cross-cultural experiences are viewed to be an extremely effective approach for participants to increase their cultural competency. To increase their capacity to practice with a client-centered focus, it's necessary that occupational therapists expand their worldview and openness to cultural differences.2
The experience that cultural immersion provides will likely develop students' cultural understanding and empathy more than simple didactic approaches, which may lead only to cognitive knowledge.3 Integrating academics and direct global experience will inevitably raise the cultural sensitivity of future occupational therapists. This hands-on learning approach should be considered an invaluable tool for our profession.
What is International Service Learning?
International service learning, or culturally focused community-centered service learning, is "direct cross-cultural contact occurring through work with a community in which individuals are involved in the social, political, cultural, and environmental aspects of that community.3
Though there's great value in domestic service learning, international service learning will evoke greater self-transformation because it involves a higher degree of cultural differences, challenges, and the need for self-awareness due to total immersion into novel social and physical environments.4 International service learning experiences will promote higher-level problem solving skills, critical thinking, improved communication skills, and an openness to cultural differences.2,5
When occupational therapy practitioners directly engage with people in a setting that's outside their familiar realm, they learn the four components of the Culturally Congruent Care Model - cultural diversity, cultural awareness, cultural sensitivity, and cultural competence, which results in enhanced cultural consciousness in professional practices.6
The integration of the four components of the Culturally Congruent Care Model will help develop astute practitioners.
Cultural diversity occurs through exposure to other communities. Cultural awareness is a cognitive understanding of the culture. By combining the two, cultural sensitivity will lead to cultural competence.
Cultural sensitivity is a deeper knowledge that will produce a change in an individual's perspective and attitude toward people of different backgrounds, which will lead to openness to engage in cross-cultural interactions. Finally, by integrating cultural diversity, awareness, and sensitivity, therapists will become culturally competent clinicians with the capability to adjust clinical behaviors, actions and practices to meet the cultural values of each client.2
Reciprocity and Reflection
The transformational process of the international service learning experience truly occurs when reciprocity and reflection are intentionally implemented. Reciprocity produces mutual respect, understanding, and responsibility between all people involved in the service learning exchange.5
In a research study, prior to experiencing the cross-cultural exchange, healthcare students believed they were traveling and immersing themselves into a foreign community solely to give to underprivileged people. Surprisingly, after completing a service learning project, many students felt they received as much or more than they gave.
By participating in daily activities, connecting with locals, facing environmental and physical challenges, and dealing with language barriers, students felt empowered and formed a deep respect and understanding for how others live.2
Due to the challenges of participating and experiencing unknown circumstances that occur during international service learning projects, it's vital that guided self-reflection be incorporated to facilitate the learning process. By immersing themselves into a situation where their values, beliefs, and ideas may be in the minority, occupational therapy students will need to re-evaluate themselves daily.
Students will undergo an expansion of their normal routines, assumptions, conscious and subconscious values and beliefs, and face their limitations. A time for self-reflection is necessary as they begin to understand themselves in relation to these new encounters.
Thus, it's essential that the reflection process be deliberately designed to elicit growth and development of the learner and to make connections with cultural competency theories learned in the classroom.5
One OT's Story
Recently, I had the opportunity to partake in the 25th Anniversary Celebration of Asha, a nongovernmental organization that empowers people who live in the slums of Delhi, India to improve their lives.7
"Asha" in Hindi means "hope." This organization educates people who live in the slums of Delhi to overcome obstacles and make positive changes in their healthcare, financial, and educational needs.
As I spent time with people who live in the slums, I realized the unique impact international service learning experiences can have on transforming a clinician. By purposefully integrating reciprocity and reflection into my experience, I further developed my professional and personal cultural competency.
Experiencing total cultural immersion gave me a first-hand opportunity to understand, observe, and discover the way people in the slums of Delhi live. By walking the narrow lanes, taking in the various smells, hearing the steady commotion, and listening to their life experiences, I understood more clearly the barriers they face every day, as well as the difficult obstacles they continue to overcome to advance their lives.
Due to my tangible experiences and personal interactions, I was personally inspired by their lives, integrity, perseverance, and values. As I opened myself up to their way of living I was amazed by their hospitality and generosity.
Through purposeful reflection, I identified and examined pre-conceived beliefs I had about people who lived in the slums. My reflections helped me expose judgments I unconsciously carried, and allowed me to alter my thoughts using valid experiences through first-hand exposure. My professional perspective of global social justice and equality expanded and evolved.
Kiran Martin, MD, founder of Asha, spoke about her views on the exchanges between volunteers and community dwellers: "Individuals and groups of international supporters.visit Asha and leave with valuable insights into poverty, inequality and community action. These exchanges also bring.opportunity for cross-cultural exposure that broadens horizons on both sides."8
International experiences promote responsible citizenship, moral leadership, and professional preparation for life in a global and interdependent world.5 International service learning can stimulate invaluable self-transformation as students immerse themselves into foreign communities. Future practitioners will deeply experience cultural diversity, cultural awareness, cultural sensitivity and cultural competence so they can further develop into exceptional therapists.
International service learning experiences should be an integral component of academic programs to help train and cultivate holistically minded practitioners. Through them, future occupational therapists will be thoroughly equipped to deliver true client-centered therapy.
References are available online at www.advanceweb.com/ot under the Magazine tab.
Jasmin Thomas is an occupational therapist in a special education school in New York City and owner of A+ Therapy LLC, which provides OT services in New York.