This article presents a critical analysis - carried out after ethnographic reflection of the main assumptions of occupational therapy1, within multicultural contexts. Our main focus is to question the conceptual foundations of occupational therapy, based on our collection of ethnographic material. Therefore, we raise questions about how to build knowledge within the field of occupational therapy, so that its postulates unfold in an intercultural perspective.
Ethnographic lens and critical analysis of theoretical principles and intervention in occupational therapy
As far as Menéndez is concerned, the standard medical system (SMS) is reluctant to consider cultural factors when evaluating an intervention: the ineffectiveness of working directly with cultural factors, the lack of cultural competence among health professionals and technicians, the risk of changing very complex cultural structures, the long-term effects of the anthropological techniques used, without ensuring the eradication of the problem, the changeability of social collectives in terms of their daily behavior and, last but not least, it does not take into account cultural determinants or use them in a targeted manner according to the characteristics and functions of biomedicine. , who argues that the latter is largely built on the science/culture opposition. . tours through the intercultural forum/workshops from the point of view of epistemic framing −within the emic/ethical view− analyzed in relation to the organizational/institutional entity.). An analytical approach to the conceptual basis of occupational therapy, focused on the nature of the profession, as well as its connection to occupation, health and well-being, is carried out by analyzing the institutional discourses, practices and structures associated with the discipline. The stay in Honduras and Morocco was made possible thanks to the "J�venes cooperantes". youth workers) provided in 2004 and 2006 by the Fundaci�n para el desarrollo de Castilla-La Mancha.
In 2007, thanks to the support of the I program of internships and final projects in Development Cooperation, and under the guidance of Dr. Participants in this study were selected through purposive sampling, according to the project's selection criteria. The method used in the assessment and initiation processes was Participatory Action Research (PAR), based on participant observation, in-depth interviews, as well as constant meetings with different actors involved in the process.
In 2011, training was carried out regarding the importance of games in children's development for members of the Instituto de la Niñez y la Familia de Ecuador, in the Bolívar region (INFA-Bolívar), as well as for educational and family mediators in various children's centers due to a cooperation agreement between INFA-Bolívar and Evergems city council (Ghent, Belgium). Also prior to the training courses, and during these, participant observation was carried out, accompanied by technicians in their supervisory and advisory duties, around different centers in several assistance areas of INFA-Bolívar.
Semantic dimension analysis
In all my interviews with the nursing staff, it became clear that, according to most Hondurans, a profession should not be considered therapeutic. In Honduras, only a minority of people are able to have an occupation that: fulfills personal needs and desires; is freely chosen; is associated with the person according to individual roles and skills while exercising control over his or her environment. In order to approach the context of Honduras' disabled people - using practical examples in my training lessons - I visited different centers and associations for disabled people.
At that point, I finally got to grips with the nurse's question challenging the therapeutic effectiveness of the occupation in Honduras, as well as her emphasis that my explanations were foreign to her, as part of a particular vision: my occupational therapy. Lack of choice when searching for meaningful occupations was one of the recurring themes in the ethnographic narratives we obtained in Iringa (Tanzania) - a study on stigma related to occupational performance of HIV-positive people. An example of this is the limited access to certain occupations, such as children's free play in communal gardens and parks – within children's centers – in Bolívar's mountain areas.
Thus, children's centers in the Bolívar region, which are more remote due to distance and rugged terrain, did not have access to community gardens or recreational areas for children, unlike other less remote centers near the areas urban and in milder weather conditions. Due to the precarious working conditions and her need to provide her children with the basic means of living, she was forced into prostitution.
Pragmatic dimension analysis
Ultimately, the basis and pillars of occupational therapy, which refer to the individual − associated with independence and autonomy − and others that allude to meaningful employment − in relation to the relevance and purpose of a given task for a particular person − are questionable. Burkina Faso (Zango, 2010). Such an activity does not have the same name in Burkina Faso, because its designation belongs to the unit in which it is carried out: bathtub or shower. The commonly used term that refers to the activity in question is to wash oneself.
She was told which tasks she should perform independently - obtaining and using supplies, soaping, rinsing and drying body parts, maintaining a certain position in the bath and moving to and from the bathing area (American Occupational Therapy Association, 2008 ). Religious practices are classified within the scope of activities of daily living (ADLs) according to the American Occupational Therapy Association (2008). This activity, which according to the therapist's professional culture fits into the self-care category, and the time spent on it, was also used by women for other purposes, such as walking from the community to the river, to tell the anecdotes of discuss the week. , their fears and concerns.
Profession as a therapeutic method should be conceived according to the quality that each person associates with it and not according to standard forms of classification. This is due to the fact that these categories belong to a minority view, which is clearly related to Western cultural values, a framework within which most of the theoretical construction of occupational therapy takes place (Hammell, 2009a: 109).
Syntactic dimension analysis
This technical advisor, who was not a native of the sierra, said, as if stating the obvious, that children in the area did not play because they were wawas de sierra (mountain children). These, according to the indigenous worldview, believed that children's role was to look after their younger brothers and sisters and take care of the family's animals. The complete disregard for local differences within the region served to perpetuate structural violence visible through identity discourses ─improving children's living conditions throughout the province and interaction practices, without, at least in practice, each area's dominant worldview in mind keep.
In Honduras, as in other countries, there are large differences between the health care services provided in some of the regions of the country. As one of the nurses at San Pedro Sula Hospital (Honduras) argued: “[…] one already knows from birth…he will live more or less time…when a teenage gang member (mara) goes to the hospital, he brings with him all his family history, all the violence he's been subject to...and I always wonder if his life could have been different...but they're almost dead by the time they get here. Structural violence is present in the institutions where occupational therapy is carried out, fueling controversy between the ultimate goals of the intervention—to promote and recover people's occupational health—and the way in which the institution enforces and enforces these goals.
For example, in the first months after the opening of the Mental Health Employment Center in Houndé (Burkina Faso), the Chief Medical Officer of the Health District, responsible for the management and supervision of the medical staff, decided that anyone using occupational therapy should not to exit the program. We also want to outline elements from the syntactic dimension analysis, such as contradictions that emerged in the assessment of the above-mentioned project in Nador (Morocco).
Conclusion
As a result, the development of occupational therapy from an intercultural perspective requires new forms of building knowledge about the profession. Thus, this convergence of different forms of knowledge will encourage a questioning of the theoretical and practical position of occupational therapy and highlight the ethnocentrism of the discipline. In this regard, and according to Ibáñez, one must question the beliefs of occupational therapy.
This author considers that in order to question the effectiveness of occupational therapy interventions, the need to assess the concepts, protocols and evaluation scales of the discipline is prioritized. Likewise, occupational therapy's intercultural approach to the construction of frameworks encourages pragmatic relativism. Occupational therapy's professional culture refers to knowledge, beliefs, concepts, perspectives, ideas, norms, assumptions and values acquired by therapists in the training process and thereby influences their own view of occupation and forms of intervention (Hammell, 2009a: 8).
This involves consolidating a more flexible and comfortable attitude towards questioning the theoretical development of occupational therapy, fostering a fluid and critical identity, meaningful in any context in which it is applied. What forms of synergy are achievable between medical anthropology and cross-cultural anthropology for the development of occupational therapy.
Bibliography
No obstante, estas son algunas de las preguntas que nos gustaría plantear: ¿Están los terapeutas ocupacionales dispuestos a adoptar una perspectiva intercultural tanto en la teoría como en su práctica diaria, conociendo sus implicaciones? Interculturalidad en salud y eficacia: algunos indicios de uso de las ONGD con proyectos de salud en América Latina. Orientación sobre interculturalidad Segunda Parte El enfoque intercultural en las políticas públicas para el desarrollo humano sostenible.
Shaping occupational knowledge: Exploring the cultural underpinnings of the evolving concept of occupational identity.
