Not enough occupational therapists in Malaysia


  • Health
  • Thursday, 16 Oct 2014

A patient with radial nerve palsy undergoing occupational therapy.

Although occupational therapy is crucial in patients’ rehabilitation, not many know about this field of medicine.

Every day we wake up, brush our teeth, change our clothes and get ready for work or the day’s routine. Nothing to it, right? 

But for some people, a car accident, a workplace injury, or some other misfortune could result in injuries that make all these actions that we take for granted a major challenge. For some patients, the road to recovery and normalcy begins after getting their basic treatment at the hospital – and it can be a long uphill road.

To regain use of their motor organs, patients’ most important healthcare professional is the occupational therapist (OT). According to the World Federation of Occupational Therapists (WFOT), occupational therapy is a client-centred health profession concerned with promoting health and well-being through occupation.

Occupation is not just about the job we do but everyday activities that people do as individuals, in families and with communities to bring meaning and purpose to life.

Marilyn Pattison, president of the World Federation of Occupational Therapists.
Marilyn Pattison: A large part of our job is about motivation and encouragement, in getting a patient to believe they can do what we are asking them to do.

The primary goal of occupational therapy is to enable people to participate in the activities of everyday life.

“At the end of the day, it’s about quality of life as well. Often, people with disabilities or are injured lose the ability to do things that well people do, so it’s about restoring that ability so they can be active and participate in a meaningful life,” said WFOT president Marilyn Pattison who was in Kuala Lumpur recently to meet with industry peers. WFOT has 84 member countries currently, including Malaysia.

Pattison added that occupational therapists not only work with individuals, but some also with a community group, a city and even a country as a whole.

Worldwide, registered OTs number about 450,000 and the average worldwide ratio of OTs per head of population is 4:20,000.

Across the world, many countries have a ratio of 5:10,000 population, and broadly speaking, that would be the ideal ratio.

In Malaysia, there is a shortage of registered OTs; we only have 1,400 registered OTs, or a ratio of 1:20,000.

This shortage is also common in many countries due to the profession’s level of maturity.

“For some countries, it’s due to a lack of awareness of the profession and therefore, young people are not necessarily exposed to it. (This happens) especially if occupational therapy is at the stage of development where (OTs) are hidden away in hospitals, so unless a person has an injury, he or she won’t be exposed to an OT,” said Pattison, who is based in Forrestfield, Western Australia.

Professor Nathan Vytialingam, president of the Asia Pacific Occupational Therapists Regional Group.
Professor Nathan Vytialingam: Very few professions work with both physical and mental health. We look at a person as a whole; that’s the beauty of it.

In Malaysia, 90% of OTs work in hospitals whereas in Australia, 35% of OTs are in public hospitals and 65% in non-governmental organisations.

“Occupational therapists are needed in hospitals, but what happens when people are discharged? There has to be follow-up and OTs are cost effective because we can actually speed up the process of getting them discharged from the hospital and assist them towards becoming independent at home,” explained Pattison.

An ageing population will also lead to the need for more OTs, especially in countries like Japan, even though it has the highest number of OTs in Asia right now with 37,000 (5:10,000).

With older people, falls are a big issue. Modern society is also witnessing fewer families looking after the older generation, even in Asia.

“The home delivery system (home care) needs to be looked at in Malaysia. We need elderly daycare centres. These will save the Government money. The key is being able to keep people in their homes,” said Asia Pacific Occupational Therapists Regional Group president Prof Nathan Vytialingam.

“In Malaysia, we have health clinics all over and if those clinics have OTs, people don’t have to come to hospitals. So, it’s a matter of creating positions there and then hospitals won’t be so crowded,” he added.

Australia has a population of 22 million and 15,000 OTs, 10 times more OTs than Malaysia. One of the reasons is the profession first began in 1942 there, compared to in 1958 in Malaysia.

However, occupational therapy is slowly gaining recognition in Malaysia.

One of WFOT’s work is to track the development of the profession in different countries. Government support, awareness and understanding of the profession spur this development.

“As the profession develops and starts to be practised more in the community, a broader range of people get access to them and the profession then becomes more recognised.

“In Australia, the profession is very well-known because we work throughout the community, from children to the elderly. We also work with people who are well because they can still be prone to lifestyle diseases like diabetes and stroke, which in themselves can be very disabling,” she added.

“So on one end, OTs put in interventions that help people get better or manage their injuries or disabilities. Then we also work with people who have no symptoms, but are still vulnerable, so our role is also about injury management and prevention,” she said.

In rehabilitation, one profession cannot provide all the solutions.

“When we look at rehab, we work as part of a multi-discplinary team. This team could include the doctor, physiotherapist, OT, speech pathologist (for a stroke patient), social worker (if involves elderly care), or a psychologist and psychiatrist (for mental health care), who all work together to assist clients to recover or reach their maximum potential,” said Pattison, who has 40 years’ experience as an OT.

One aspect which is often overlooked in occupational therapy is mental health care. According to the World Health Organisation, one in four people develop some kind of mental illness at some point in their lives.

In their work, occupational therapists use what is known as a biopsychosocial approach.

“We look at a person physically, mentally and also within his or her social environment,” shared Pattison.

People with physical injuries also need help maintaining their mental health.

“Very few professions work with both physical and mental health. We look at a person as a whole; that’s the beauty of it,” said Prof Nathan. One of the key factors to physical recovery lies with the mind.

“A large part of our job is about motivation and encouragement, in getting a patient to believe they can do what we are asking them to do,” said Pattison.

“Our role is to help them set their goals and then make sure they can achieve it. The challenge is keeping people motivated.

“People with physical injury or disability go through a natural grieving process, so it’s about maintaining the progress despite it all, and looking at their environment. Their family is part of their environment. So we have to work with their families too.”

Without a doubt, occupational therapists’ jobs are demanding and require lots of patience. “It’s very rewarding to see the outcomes we get with some of our clients. People are pretty amazing, actually. I also often bump into people years later who will come up to me and say, I always remember what you said,” shared Pattison, with a warm smile.

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