Ten Years of Occupational Therapy in Africa
April 22, 2015

By Jamie Wetherbe/USC News

Bonnie Nakasuji ’74, MA ’94, OTD ’08 first went to Ghana in 2003 with a simple mission. She wanted to match patients with wheelchairs.

Two years later — thanks to her passion for occupational therapy and a good deal on airfare — Nakasuji returned to Ghana with 10 students from the USC Chan Division of Occupational Science and Occupational Therapy to help adults and children with disabilities.

During the past decade, Nakasuji, an adjunct associate professor at USC Chan who coordinates the division’s leadership externship to Ghana, has ushered 232 USC occupational therapy students to Ghana, taking on some 50 duties, from arranging air travel to lecturing at universities.

“It’s just been an amazing journey. When a student has an opportunity to give professionally, it’s really rewarding,” Nakasuji said.

“I have always been interested in international work, and I wanted to do something bigger,” said Erin O’Donnell MA ’13, OTD ’14, who first traveled to Ghana in 2013 as a student and returned the following year as a practicing occupational therapist. “I’m planning on going back forever.”

Traditionally, Ghanaian society has held an attitude that those with disabilities are “useless,” Nakasuji said. It’s even more pronounced in small villages.

“People believe that those with disabilities are cursed, so families who have children with disabilities throw them away,” she said. “They have to get rid of the curse; they don’t want it to permeate the family or the village.”

Survival stories

Social centricity in an African village requires that each person contribute to the group’s livelihood.

“Some people in Ghana think people with disabilities can’t do anything, so they’re not only cursed, [they’re] worthless,” Nakasuji explained.

Many Ghanaian children have a story of survival, Nakasuji said, including a boy she met who remembers his father taking him to the bush and leaving him to die.

“Infanticide is alive and well in Ghana,” she said. “But I want to emphasize this attitude is changing.”

In fact, advocacy for people with disabilities in Ghana took a giant leap forward in 2006 when the disability rights law passed, which protects people with disabilities from discrimination, exclusion and abusive or degrading treatment.

“The country has really changed in the last few years, with more locally run and locally funded programs,” said Mariko Yamazaki MA ’10, OTD ’11, who first went to Ghana as a student and now co-coordinates USC’s leadership externship.

Sewing, sandals and carpentry

USC occupational therapy students have worked with children with a range of disabilities at the Mephibosheth Training Center since the day it opened in 2005.

The goal of the boarding school, which takes its name from the only disabled child mentioned in the Bible, is to train children to take on one of three vocations — sandal-making, sewing or carpentry.

“If they learn a skill, they can contribute to village life and they won’t be mistreated or thrown away,” Nakasuji said. “A sandal-maker, seamstress and carpenter are considered really good, middle-class jobs.”

Occupational therapy students present simple, fun activities related to sewing, leatherwork or woodworking and offer feedback on the child’s capabilities and strengths, as well as strategies to help the child perform the job or a specific task.

“Some of these children have really significant disabilities that we really don’t see in the U.S.,” O’Donnell said. “It’s just amazing seeing how capable they are.”

Mentoring students

With the launch of the country’s first occupational therapy program in 2013 at the University of Ghana, USC students took on another role serving as mentors to incoming Ghanaian students.

Since occupational therapy is so tied to culture, Nakasuji and Yamazaki wanted to assist Ghanaian students without imposing an American perspective.

“They don’t have any [Ghanaian] OTs yet, since the first class from the university hasn’t graduated yet, so I don’t know what OT will look like in Ghana,” Nakasuji said.

Adds Yamazaki, “We’re at this interesting place where we really want to support [the university] and spread OT to new places, but we don’t want to intrude on their own culturally relevant professional identity.”

Nakasuji thought an email exchange program between the two sets of students would be the ideal solution.

“The [Ghanaian] students have a resource for getting information about how OT works in certain situations,” Nakasuji said. “It’s a way for the OT students to develop a professional identity when there are no OTs in the country . . . and this is a perfect leadership activity for our students.”

A profound impact

Year after year, USC students tell Nakasuji how their experience in Ghana has profoundly impacted how they practice.

“It completely changed the trajectory of my career,” said O’Donnell, who now works in pediatrics. “I realized I’m meant to be working with kids; these trips have given me a passion.”

Yamazaki added, “I’m much more aware of how to support the whole family and each client’s unique family context, whether they live across the world or down the street.”

O’Donnell and Yamazaki most value Nakasuji’s lessons in cultural fluidity over cultural competency, a term often used by medical organizations, including the American Occupational Therapy Association.

“Cultural competency implies something static. It makes us feels we’re accomplished when we never will be,” she said, referring to the ways in which cultures change over time.

Nakasuji teaches students to bask in the cultural differences of Ghana and to apply that same openness when working with a client at home.

“It’s easy to see differences when you’re working with someone who’s very different,” Nakasuji said. “But I want [occupational therapists] to keep that same mind-set when working with someone very similar.”

While a clinician and patient might share experiences — the same hometown, ethnicity and religion — Nakasuji said a clinician can never fully understand the client’s experience, culture or context.

“As therapists, we think we’re more culturally competent than we are,” she said. “I believe that we’re all very different. For us to be truly client-centered, we must maintain an openness that has to be culturally fluid.”

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