On episode 13, Dr. Hiba Zafran, an occupational therapist and psychotherapist, talks about her experience with working alongside individuals from indigenous communities in Canada and finding how OTs fit into that role. We also discuss the unique strategies to support this population that strays away from the medical model and focuses on listening first and providing cultural safety, no matter what setting we are in.
Resources mentioned in the podcast:
Check out the infographic of some of Dr. Zafran's work here
Katie Caspero: Welcome to the OT Digest podcast. I'm your host, Katie Caspero, the founder of OTgraphically.com. Where I synthesize research into visually appealing graphics. On this podcast, we take research and make it more fun and interesting in order to quickly hear the most updated evidence going on in occupational therapy, all around the world.
I interview research authors about what research they've done and what they're currently working on and key takeaways they'd like OT clinicians to know. I hope you can use this information and incorporate it into your interventions the very next day. Thanks for listening.
Well, welcome everybody to the OT Digest podcast. My name is Katie Caspero, and I'm the host of today's episode, again. Today, I'm excited to have Dr. Hiba Zafran here for us to have a great conversation about what she's been working on and all the awesome, you've been doing a lot, so I'm excited to hear, even just in the past year, I went through and looked at a lot of their articles and saw, wow, this is very relevant things that we all need to hear.
So I was really excited to reach out to her and have her on the show today.
So Hiba, would you like to introduce yourself and explain a little bit more about you?
Dr. Hiba Zafran: Sure thanks, Katie. Um, and this is, uh, I've created podcasts for teaching, but it's my first kind of invited to be on a podcast. So thanks for that.
For the experience. Um, so I am a duly licensed occupational therapist and psychotherapist. Um, and right now my primary, um, role is I teach in an occupational therapy program at McGill university in Montreal, uh, in Canada, which is located on unseeded Mohawk territory. Um, I go by the pronouns, she, her and my, I guess I'll just unpack that a little bit more.
My teaching is, uh, primarily focused on. Mental health community-based practice, cultural safety, um, and integrating more. So, I mean, I'm still working on it, right? We're all trying to figure it out and teaching and an equity and justice lens, something I've been interested in for a long time. Uh, the other thing that I do at McGill is, uh, I've been a curriculum developer in our indigenous health professions program that serves the whole faculty of medicine and health science.
And the rest of my both research and admin, um, projects. Uh, I guess I have to say that I'm not primarily a researcher. Um, so when I do research, it's out of interest, curiosity, opportunity, uh, community request, et cetera. Um, so. The rest of my stuff is all social justice-focused. So both on campus, uh, in terms of a whole bunch of different equity committees, um, And then nationally in Canada with the Canadian association of occupational therapy, uh, creating a joint national position statement on social accountability and occupational therapy.
I've been involved in a couple of other things. Um, so if I come back to research, uh, like I said, the past little while, and you noted, um, all of a sudden I've been involved in developing. Indigenous health curricula in occupational therapy and response to the truth and reconciliation commission of Canada and the health inequities faced by indigenous peoples in Canada.
Um, and so as I started getting myself situated in that a few years ago, um, and building relationships. It also shifted into, um, wanting to not just teach our students, but to take, or to find ways of reciprocating, what we were learning with community partners. And what else, what could we give back from academia?
Um, so that's how some of those projects S uh, got going and. And some of my other research is also conceptual. Just trying to think outside the box for how OT can move forward equity and justice principles. And then in terms of clinical practice, I haven't, um, well, I've got a history working in youth mental health in early psychosis, immigrant youth, gender questioning, uh, racialized youth and so forth.
Um, I guess it's been a few years since I've practiced, but I'm picking up a practice again, this August with Montreal youth who identify as BiPAP and LGBTQ. So, um, I'm actually excited about that to have a foot back in the clinical world. So that gives a little bit of ago around, I guess.
Katie Caspero: Yeah. You’ve done a little bit of everything, which I think is really powerful and helpful to, to hear from you. So you kind of have, you know, everybody. Everybody in mind from academia to the clinicians. So that's really helpful.
Um, so can, can you explain a little bit more? Um, so I, I, what I heard you saying, let me make sure I understood correctly is you are working on curriculum, but you're really trying to work on applying that in the community, or you were saying you wanted to, um, just, can you talk a little bit more about what you meant by that?
Dr. Hiba Zafran: Yeah. Um, I'm trying to figure out. So most OT curricula in North America, um, our Western-based Western conceptualized, many of our OT programs are heavily dominated by medical, biomedical understandings, um, sciences, ways of thinking and reasoning. Which is important, right? Um, and occupational therapists have of course, multiple different ways of thinking and focusing, et cetera.
When it comes to looking at health inequities, multiple or different marginalized groups or groups are made vulnerable by social and political structures. So by structural racism, um, the gender binary, uh, colonization, et cetera, what kinds of reasoning, actions learning content skills, competencies, um, Et cetera will actually equip occupational therapy students when they enter the workforce to see it, to analyze it, to grapple with it and to work within systems that can be very oppressive to different groups and create those inequities.
And while when I first started doing that, Um, really wanted to take the approach of, well, what do the communities around us need? So the indigenous communities around, um, McGill University, where, where I live and teach our , which is Mohawk, um, James bay Cree, or the territory, which is in Northern Quebec, uh, in UAE people, um, Well, and you, it means to people.
So it's a bit redundant if I say it that way, all the way in Northern Quebec and Nunavik, um, there are other, uh, communities there's, uh, you know, urban indigenous communities, et cetera. And it was, well, what do they want healthcare professionals to know? And, and of course, I have not been doing this work in, in solo.
I've been doing it with colleagues, with indigenous colleagues, peers, et cetera. And the more we I got into this path and also at the national level in Canada, uh, Our new profile of competencies for occupational therapists is coming out with a strong new section on equity and justice skills. So I was involved in that, um, as part of an advisory group on indigenous engagement and the more we went along and I say, we, because it's not just me.
Um, the more, it also became clear. Um, that it's not just teaching our students and ourselves. Um, but also how do we attend? Not just to the diversity out there, our clients and dissipated clients, but also the diversity within who'd you work with as an OT. Um, are they experiencing marginalization and oppression within the workplace as well as colleagues, students, OT students?
Um, so education. In this Western biomedical paradigm, um, presumes that all of our, you know, that we have a white audience, which isn't the case, obviously. Right. And so what does that mean for teaching and from there? So it's kind of expanded and because I've maintained or built relationships with different community members.
Um, both for them to come and teach, uh, for me to learn, et cetera. It just made sense to also reciprocate. And, um, so far the projects I've been involved in have been very much around, uh, understanding the reasoning of occupational therapists within the context of structural violence within the context of a Western.
Dominated models of OT. I does that help a little bit? Yeah,
Katie Caspero: definitely. I guess that was my question.
How did you bring those community partners in? Cause I think that that's really powerful that you asked them first, you know, kind of what, what do you need, what do you need from us?
Dr. Hiba Zafran: And it, and, and that's part of accountability in, in education or practice or healthcare services.
So. Um, that framework of accountability is that, um, one-on-one as a, as a, you know, therapist and client, or if say you're, you know, a team leader in a rehabilitation program or you're teaching a course or that kind of thing, accountability comes in just thinking through first of all, well, who decided what the priority content was, right.
And going from. And whose perspectives are represented here and who am I missing or where are my blind spots and going from there. Um, and it can be from the interpersonal, like in the therapeutic relationship all the way up to organizations and systems. And I will say at this point, I, my heart goes out to all of us.
And I include myself in that who as individuals are trying to do this, but within systems. That don't change or without supportive leadership or enabling environments, um, to support any advocacy and equity focused actions of individual OTs. We also need enabling environments to be able to.
Katie Caspero: Yeah. You mentioned the Treaty and Reconciliation Um, I can't remember the
last word, of Canada. Sorry. There was another word in there. Um, that seems very. Like, was that a really big deal? I don't know much about that, but that seems like it. Step in the right direction. Was that new or?
Dr. Hiba Zafran: Yeah, so, well, w recently, no, it's certainly not the first, uh, big initiative.
Um, and I will say that it's truth and reconciliation commissions, um, South Africa, uh, Canada. I mean, it's not exclusive to Canada in terms of a colonial history and the impact on indigenous health in the states, too, in terms of the. Oh, the way that I guess the right term or the term that's used in the states is native Americans have been treated over the years, um, by or mistreated rather, um, by our governments.
So, um, historically in the creation of Canada, uh, through that process, um, there was an explicit, um, By the British Commonwealth to assimilate, uh, and they were out of Cate, indigenous peoples, including the creation of reserves, uh, removing children from their communities and putting them in residential schools and, um, where they experienced quite a bit of sexual, physical, and so forth abuse, um, taken against their parents.
Well, and so on. Um, And the last school only closed in 96 in Canada in 1996. And the purpose of the schools was to, uh, re to quote our first prime minister. John McDonald is to take the Indian out of, out of the person. Um, so they went to allowed to speak their native tongue. Uh, they had to dress according to, um, British or French standards.
And so. Um, I mean, in fact, it's a genocide and again, kind of does not the only place and residential schools is actually the model by which apartheid was established in South Africa. So to come back around, there was a huge, extra, the largest, so far, um, lawsuit against the. Settlement where the Canadian government paid out.
I'd have to double check how much money, but it was a lot of money. It's the largest settlement to 86,000 survivors of residential school. And what they chose to do the recipients of the settlement is to take that money and put it back into creating a truth and reconciliation commission. So over the course of three years from 20.
1112 to 2015. Um, there was a three-year process where the funding was used to interview and in public spaces as well, testimonial as well as privately to understand the impact of this history on indigenous communities. Over 6,000 individuals shared their stories. There's a lot of research into, um, Hidden documents, uh, statistics.
Um, it's known as the dark history of Canada and the truth and reconciliation commission, um, released their final set of reports with calls to action, including in health education, child welfare, uh, law, and so forth. And so Canadians are asked to, you know, meet these calls to action, and it's still complicated.
And, uh, So we still have a very, very long way to go. There's an incredible amount of history to undo and relearn. So in Canadian occupational therapy, um, we've had wonderful leadership. Um, I'll name, Angela Phoenix, Angie Phoenix, and Karena Allavara who are two occupational therapists who are also matey women.
It's one of the, um, indigenous groups in camp. And they're both OTs and they've both really taken a leadership role with allies around outlining. So what is the role because at the indigenous communities, um, what does that mean for what we need to learn as OTs or OT students? I hope that wasn't too long.
Katie Caspero: Is that okay? Nope. Yeah, that was really helpful just from not being from Canada and knowing
that history that was really helpful for me,
Dr. Hiba Zafran: for your American audience. Um, you have the exact same history of genocide in the states. It didn't there. Didn't used to be a border indigenous communities call the American north, all of north America turtle island.
So for them, the border between Canada and the states is not theirs. Um, and so the same processes, the only differences. Different you're in a different space politically right now than, than we are. That was kind of my next
question.
Katie Caspero: Um, it seems like I remember where you were saying earlier, you know, your heart goes out for those that are in places where their leadership is not there.
It seems like you maybe have some of that leadership. Would you say that you have maybe some leadership in Canada been really helpful for this, for you to be able to do this work? And if there are people. Are not having that leadership. Do you
have any advice or, yeah,
Dr. Hiba Zafran: I think, yes. Um, so first off, yes. Um, we have leadership at, um, national level, but it's taken a long time for that leadership to be recognized in formal ways.
So with positions, with funding, with salary, et cetera. So it, so, you know, there's a difference between, um, Being vocal and heard versus actually being a formal, legitimate leader, right. With a position with a salary that you're actually paid for your quote unquote volunteer work. Right. Um, so, and that's still evolving.
I mean, I, I, I named two indigenous OTs, um, and now there's a task force within the Canadian association of occupational therapy. Um, looking at a more structural response to reconciliation in the profession. Um, but now also we're thinking, okay, well what about, um, black OTs and black communities and, uh, LGBTQ two spirit, uh, LGBTQ plus communities and racialized communities and, um, OTs with disabilities or disabled to use, depending on their preference of how they would, you know, would want to be named, um, and just also too in our, in our profession.
Um, so now that's starting to slowly expand, but it's not easy. It's it's certainly is, is not easy. So for me, leadership, I think needs to be thought of in quite diverse. So first off, wherever you're situated, whether you have a lot of power or not, my first question would be, do you know who around you can be an ally and mentor a supporter, um, a teacher and so forth, an opinion leader as well.
And that may be someone with a formal title was job. It is to do that, but it may not. Right. It could be, um, an activist family member. It could be, um, the young student that you've got in your stash right now. Um, that could be a collaboration with a community organization that does a lot of, um, advocacy work.
So the first piece is to identify for me leadership, you know, it's to expand the notion of leadership. Not think of it in traditional titles kind of ways. And was there an indigenous elder who could be a mentor, is there and so on. Um, so to identify around you, who you can learn from outside our usual box of OT, That's because when we think of, you know, like who's going to teach me, I'm going to go find like someone who has, you know, written about this, um, or researched this.
And I think of expertise when we're talking about equity and justice or anti-oppression as something that we have to think of in much broader terms in terms of experiential knowledge, in terms of on the ground, in terms of across disciplines and across positions. So that would be my first thing in terms of just broad notions of leadership and mentorship.
And then the second thing I would, I would say, um, and this is known as political reasoning. Um, and, uh, if you'd like me to share some resources on, you know, any of this, once you okay. Want to post out your podcast, just let me know. And I'm happy to share a couple of things. Um, let's step zero in political reasoning is building relationships and building relationships is not just about, well, I have to have a relationship with my manager, my director, my team leader, mine, you know, my teacher, my whatever, um, relationship building has to do with finding peoples and communities.
That align ethically with what you're trying to do that could be partners, stakeholders, allies on either, um, circumscribed projects, um, or broader like a longer term relationship building. Um, and it might be with someone you'll think you already have a relationship with, right? Like a colleague or, um, a leader that you think you already have a relationship.
But it's a professional relationship as opposed to an advocacy or activism or a political relationship in, in that broader sense. And by political, I mean power, I don't mean political parties. I mean, power, power sharing who has power, et cetera. So relationship building and getting and listening to each other, even figuring out relationships with opponents too, and then trying to figure out what are some shared.
What are some overlapping places that you agree on in terms of priority or ethics or theories or actions, or, um, even if you disagree on how to get there, right? It could even be like, for example, renegotiating the inclusion exclusion criteria for a rehabilitation program that, um, marginalizes or excluded.
Very specific groups of people and causes more inequities. And that could be based on our assumptions of who has rehab rehabilitation, potential our assessment processes that, um, focus more on white norms or able-bodied norms and so on, or our own assumptions of what it should look like. Um, so it could be something around renegotiating criteria.
I mean, criteria. To access care is a huge political thing. We think of it in terms of rehab and medicine and care, but completely political because it's got all these implications for, um, outcomes, for employment, for housing, for all kinds of things. Right. Um, so it could be that, you know, so say you want to look at criteria for something who else wants to change it.
Can you find that. Is this, could this be a shared project? What can you build together? We are all stronger together is that so, and then from there you're building partnerships and trying to figure out strategically. So how do we move this forward? Who actually has power to change that criteria?
Sometimes you're surprised. Oh, oh, we can just do that ourselves. We just inherited these criteria from, you know, previous people who were running the program and. I guess we could just, you know, sit down and have a conversation and figure that out together. Um, based on our waiting list, based on conversations with family members or a patient advisory committee, um, data from our local communities or sectors, and sometimes you need to figure out, okay, well, who does have the power to change that and to try and find them and figure out what will it take for them to be convinced, right.
If there's a lot of resistance, if there's not a lot of resistance, that's great. Sometimes what it takes is. Right. So a report of some form sometimes, um, what it takes is public facing or media campaigns. Sometimes what it takes is whistleblowing. And if you'd like concrete examples of each of those I can give like quite varied clinical examples on each of those, if you find that useful.
Katie Caspero: Yeah. Maybe a couple. Um, yeah, I'm gonna wait to ask another question cause that's pretty cool. That a kid. But if I ask another question while at the same time, so yeah, if you, if you could give a couple examples of those, I can think of a few, but
Dr. Hiba Zafran: why don't you share one of your examples?
Katie Caspero: Yeah, I was just gonna say that.
Um, so I, we, I, um, worked in a city and, and a lot of times we would have, we had, um, I am a pediatric outpatient therapist, so we had, um, A lot of families that were bused into their appointments. Um, and a lot of times that would cause, um, late people, late people that have to cancel completely missed their appointment, you know, not in their control at all.
Um, and we had a cancellation policy and it was okay, you missed two you're out and like, or I don't remember actually what it was that seems aggressive, but, um, And I just remember feeling so bad for the families because it was not in their control, you know, and it was, it was happening a lot. And I think it just did not seem fair that we would have to take away something they needed because of,
um, Just the situation they were in.
And, um, I don't know if this isn't a great example, but that's just the one that really made me like, feel like this is a structure that is not working for this.
Dr. Hiba Zafran: That's a great example on how did you address that?
Um, I think I just kind of personally just didn't enforce the rule and just. If someone's going to ask me, I'm going to explain why.
So that was kind of, and, and other people around me had the same kind of philosophy, but some people didn't. So I think just trying to be the model like this is when they did ask me, I would explain why, but other than that, you know, I kind of felt stuck.
Dr. Hiba Zafran: So that's a great example of this. Things falling on individuals, systemic problems, falling on individuals, and depending on who your manager is, or insurance policies, et cetera, and you could get into trouble for that.
Katie Caspero: Right, exactly.
Dr. Hiba Zafran: Because you're going against policy and I'm in my work with occupational therapists working in indigenous communities. That was a huge thing as well. Um, cancellation policies, inclusion-exclusion criteria, et cetera. Um, so in that scenario, um, there's a couple of things. One is not just having to explain yourself, but charting that, you know, the environmental barriers and really documenting and because documentation is, is it, this is quite a significant act, right?
Um, instead of, um, I don't know, a no show, no show, right. And to really document this is the third time this family was unable to attend because, um, they needed to attend to food secure. Families in poverty, transportation, injustice, um, whatever the reasons are, you know, the geographical barriers, financial barriers, um, other demands on their time, um, what they're juggling.
Right. Um, but also what we see with, with certain marginalized communities is mischief. Right. Like they don't trust healthcare systems. Um, so, uh, in the states, there's so much race based data on, um, health inequities that are created by the system. So why is maternal health and, um, reproductive health for black?
Women's so much worse than for white women, for example, um, employment, et cetera. Um, so, and with a history of a medical and a rehabilitation profession that has been racist, that is racist, able as the et cetera, there's a lot of underrepresented communities that if you don't build trust, they will not.
And then they do not have access to those services because we have things such as cancellation policies. We have the myth of like, well, motivation, just individual motivation. If they're not motivated, then they don't get to have rehab. But motivation is such a complicated thing. Do they have access to opportunity?
Sense of safety? Um, do they have insurance? There's so many levels. So even something as benign sounding as a cancellation policy can actually be quite oppressive and individual OTs are then stuck with that moral kind of, I don't feel this is right. Right. So in that situation, the few of you who were doing the same thing, and I would have suggested, or I don't know if you're slim in situation, um, I would have suggested, so charting document.
Does it affect certain groups of families more than others. And does that then lead to inequity? Right. And what's interesting too, is that think of it? Um, this is Karen Wiley. Hamill's work, not just in terms of services they need, but services. They have a right to, so moving from a need space to a rights-based because the second we're in needs, then we're like, well, this person needs it more.
Okay. And, um, and who's making that judgment call based on which worldview I had or what type of evidence and who created that evidence.
Katie Caspero: This might be a really derailing question, but do you think the medical model fits OT? And do you feel like, like, I think I've had this conversation a few times. Let me rephrase
That. Um, Yeah. Do you think as OT, we should be practicing the medical model solely,
I guess that's my big question. Do you think that that is ever an option?
Dr. Hiba Zafran: Never, never. And I will rely on evidence. Um, just, I mean, the work of, uh, Cheryl Mattingly and Mary Lawler, uh, USC in the states, um, As really helped clarify the very unique professional reasoning of occupational therapists and with activity at the center and really thinking through what is environment, what is activity, what is occupation, the person, their community, and so forth.
We're learning to expand our notions of environment, the social political environment, systems of oppression and so forth. But what Cheryl Mattingly in the nineties. Um, was not the inflaming. And then Cheryl since then has really developed, um, the narrative nature of clinical reasoning and OTs use activities to create significant experiences for, and with people, groups, communities, whichever format you're working with to actually believe.
That you can become. So, and, and if you think of the philosophy of OT doing, being, becoming belonging, we have an instinct in particular candidates to really emphasized one version of doing the objectified quantifiable, measurable progress, focused version of doing otherwise known as function, or even the term performance.
If you think of the term performance, There's an audience perform. Um, we have neglected the experience of doing, um, when we talk about flow and engagement, but do we know what the doing of underrepresented groups is as an experience, um, being that's another one that's, you know, not maybe we have these four and we're focused on doing, and I would say belonging and again, belonging.
More focused on social participation, measurable quantifiable versions. And, and I'm not bashing those. I think those are important as well, but not when they are the sole way that we see, um, and work becoming and being experiences of doing it takes a very different type of reasoning of thinking of worldviews of evidence-based types of research, types of approaches and interventions.
Um, And for me, the medical model is just one tiny, tiny, I mean, it's one element of one piece of a person it's not even the whole of the person, not even close, right. To understand an impairment and the impact of an impairment on, because I'm sure anyone listening knows that for the exact same impairment.
And the exact same objective measure of function on a particular standardized test. You might have one person who's totally cool with it. Totally fine. It's really not a biggie moving right along. And someone else will be destroyed, destroyed by that and their illness experience. Right. So, yeah, it's just so restrictive.
It's just such a smaller piece of this bigger thing that we're trying to do. As occupational therapists, if you really think of, you know, occupation and its broadest understanding. So yeah, no, I, uh, I'm not against the medical model, but I just don't see why it has to take up like all the space. Yeah. It's like a 90%.
Yeah, I understand. Right. That's how it feels in my brain. It feels like I have to conform to, because of being trans because of kind of my documentation system.
Katie Caspero: Um, doesn't go that way. Absolutely. Yeah. Kind of similar to that. Um, I really appreciated how a little while back he said, you know, we go to research first, you know, obviously that's very much my wheelhouse, I like research and that's comforting to me to go to research and say, this is what you should do.
Um, there's, you know, No situation there. They're like, you know, who did that research and what was the priority? Um, and, but you were saying, this is more, the experiential, like really need to have people on the ground and understanding the experience of people. And I just think that was, I appreciate that.
And I think that, yeah. Is really powerful. Um, and almost like about not a bottom up approach, but like a grassroots approach to, um, someone maybe to like start out if they're just trying to figure out where they fit in this.
Dr. Hiba Zafran: I mean, if you're thinking person centered, that's the heart of person centered practice, not impairment centered practice or diagnosis based practice.
Um, and the other thing about the medical model, I think that's more insidious is it's a way of reasoning. So the scientific method is deducted, right? We're trying to generalize, we're trying to find universal truths so that we can apply them with X percent certainty in a situation. So, um, If you have a certain statistic, right?
Like for a particular diagnostic category and a particular age group that there's going to be, I don't know, 70% of people with these characteristics will likely be unemployed for this and this symptom, the reason. Right. Um, and, and that's useful to know there is definitely a use to procedural, deductive or scientific reasoning.
Those are all different ways of talking about it. The Congress though, is when we listened to, um, or guided by the experiences of the people around us and what really matters to them. And that's where meaning lies, right? Because what really matters to them. And again, I'm drawing on Cheryl Mattingly's work and there was a Park's work as well.
Um, is narrative reasoning in, um, nursing bail. So call it intuitive reasoning. It's got a bit of a different definition. Um, but narrative reasoning, phenomenal logical reasoning and process of, instead of the scientific, which is going from the general to the particular, we have these general statistics and outcomes, do they apply to this person?
It's flipping it. Okay. This is a real person with specific details with specific race, gender, economic, social, political history, all of that. Real human in front of us. And then there, we interpret to what matters to them. And yeah, we do draw on procedural scientific reasoning to figure out, okay, so how can I support this person?
Gets them there. It's also a balance of both and then same with political and pragmatic reasoning. So from social pragmatics, great. I only have one consultation session with you. So various, you know, that's the context here and that will be a pragmatic reasoning, right? Like what's achievable right now or political reasoning.
What are the power dynamics at play here? And for you too, as an OT, right? In that story that you shared, um, what were the power dynamics around. That clinic or program or setting for that cancellation policy that you felt that, you know, maybe it was better not to, or you didn't feel like it was part of the realm of possibilities for you to advocate for a change in that cancellation policy.
Right? Because that's the power that's also exerted on you. And so that's political reasoning as well as analyzing the power dynamics. Um, So, yeah, it's different forms of reasoning. And I think that's the damage that the medical model does. It's when it's overly dominant, then we, we are already flexible as OTs.
Um, but that's where the reflexive piece comes in. As of right now, am I stuck in technical thinking or scientific thinking diagnostic thinking, or am I interpreting. Matters to this person, what is their experience? What is happening in their specific context than ally using the form of reasoning that's best required at this point in time, um, with him for right.
Um, and there is, I mean, quite a bit of qualitative research now in OT, right? And qualitative research, not, not talking about. Read some, you know, we collected interviews and then we applied the ICF international onto the interviews. That's a template analysis, that's deductive and it's useful, you know, if it fits the research method, that's totally useful.
There's plenty of qualitative research. That's descriptive interpretive. And it's that form of reasoning, except that when you look at critical appraisal, what is the level of evidence? It actually rates quite low. That is so rich for a therapist because yes, occupation, but also therapist to grapple with, to expand their own horizons as well.
Katie Caspero: Yeah. I do
often feel that there's this and this isn't probably a super important point, but like qualitative research should be at the same level of, you know, a level one because. That is just giving you so much of the story and that person centerdness. And like we said, probably is a good place to even start,
um, before you.You're trying to be the fixing. It
Dr. Hiba Zafran: Absolutely. Absolutely. The listening first. Um, that's the first thing with, with, um, with students I work with an undergrad is they just always want to like, oh, I will actively listen. Can you actively listen for three minutes straight? And they can't, it's so hard because you know, we have our own soundtrack going in our head or our own agenda going in our head.
Of course. Um, Yeah. There's so many systemic constraints to listening to, right? Yeah. 15 minutes to see this type of, you know, that's a systemic issue as well. It's not just all, it's an unwilling or, you know, uneducated therapist. That's not true.
When I started developing relationships, I'm trying to figure out, you know, indigenous health curriculum. We'd already had students doing clinical work. For a while during clinical field work or placements, um, in Northern territory's, um, in Quebec where the province, where I live, um, with decree board of health and social services of James bay and.
The director of allied health. When I started off is a former student. And so it was easier to reach out to her and say, Hey, Leah, you know, I'm doing this, you know, we have a few chats. I want to better understand your realities. What do our students need to be ready for it, et cetera. And the more it went along, um, the more the importance of including the systemic.
Pieces, um, or also what's known as structural competency. That's also out of the states. Um, so those are competencies that, um, individual healthcare practitioners have to be able to see and address structural issues. So structural competency. Um, and one of the things I said, well, you know, for, uh, I think you might call them capstone projects.
I call them masters research projects or professional projects. Um, I said, you know, while, if you ha you have lots of so different needs, like for example, one of the big needs that they had was like a ridiculously long wait time for the low back pain. On Cree territory and like eight months. Right. And, uh, what can happen in eight months of more damage, more pain, more et cetera, impact on mood and all of that.
And so one of the first ideas were threw around was like, if we could do like a culturally adapted, translated version of, um, Health promotion, posture, ergonomic, hygiene, all of that stuff that we could package in a nice, um, consumer friendly kind of way, uh, to be able to give people that were on the way.
Right in collaboration with, um, the culture department of the keyboard free health board, and then issue department. Um, but as we went along, uh, she was saying that the disability program services, um, she was working really hard to hire an indigenous leader, indigenous healthcare professional, and she had just hired a social worker, um, Hired or promoted or Jessica, Jessica Jackson Clemett.
And so Jessica, as a Cree woman and social worker was in charge of the disabil is still in charge of this building program services. And in particular, there, um, is a specific clinic. It used to be called the fetal alcohol syndrome clinic, but for lots of reasons, relating leading to stigma, the name was changed to the CRE neurodiagnostic developmental class.
And it had been functioning for a few years, has been functioning for a few years, but it was the first time that they had indigenous leadership and indigenous views of health and family and community with the kids. And they were really revamping the way from the medical model to a more holistic approach to working with children with neurodevelopmental, um, diagnoses, uh, living in Northern remote commute.
Is it just that I really would like it. If you got along with Jessica that took about two years of talking, just her getting, getting to know each other and err, and beginning to think, well maybe this academic researcher, person, OT person might be someone that, you know, we could trust to work with. Um, and so.
They agreed. And it was proposed as a capstone project and four OT students chose to work on it. Um, Hilary, William, Alexa, and Daisy, and I was able to get a little fund for, um, from the global health programs for, uh, an undergrad who was a nurse to join us. So it was the five of us Naomi, and we took, I don't even.
Like a semester's worth. I don't know how many months worth of discussions every week with Jessica and Amy Parsons, who was their newly hired, um, prog PPRO program planning and research officer to figure out what their priorities were. So I'm, I'm outlining this just to say that this whole project took two and a half years to even become, not even become to start.
To even figure out what is it that we could do to start. And the biggest piece was around. Um, so what are the best approaches? What are people doing? What is the best way to provide culturally safe care for these communities? And we ended up the students, um, now graduated, uh, interviewed 17 practitioners who have.
Committed. And I used the word very specifically committed, dedicated their lives. Um, the majority were OTs dedicated their lives, their families to living in and with indigenous communities and thinking of what OT services. And we created based on the evidence and we looked at literature and so forth, but we didn't look, just look at scientific literature.
We also looked at cultural safety guidelines developed by indigenous led organizations. So outside of the purview of, you know, the publication apparatus, right. Um, And we, I mean, it was an anti-colonial research methodology and the way we decided, so we had ethical approval and everything. So, I mean, we, we did follow the rules and regs around this stuff, but we got to the end and we were like, these 17 therapists are incredible humans.
People need to know that the wisdom comes from them. And so even though we stipulated anonymity in the research we offered, if anyone wanted to be listed as a consultant on the guide, that they were more than welcome to. Put their names on it. So 14 of them chose three, one to two remain anonymous, and this is where the pushing against the system comes in.
Right. Cause if we had maintained anonymity and just published it as a scientific article who has access to that may need to have access to a scientific database. You need to understand that form of language. And it's not to say that OTs don't of course they do, but not all community organizations have that type.
Access right to scientific database or, um, are called or that it really does change anything. I mean, the last statistic, I, this is why this podcast is so sweet is, uh, one of the recent statistics I saw was that the average scientific article has three to six readers, which include the authors. The peer reviewers and the journal editor.
So that's a really low uptake.
That's really low. And we also want to the guide to follow more, um, indigenous principles of storytelling. So we, I ended up, um, ghost after he'd done the analysis and everything ended up, what's known as ghost writing, which is, um, I mean, you write it as if it's one voice, right? So it's more of a story the whole way through.
And I had some funding leftover from my PhD and I was able to hire, um, an indigenous designer too. No illustrate the whole thing. And we were able to make it publicly available, PDF open. And the reason why I'm so proud of it is that it's a work of the heart. For me, it's been like, not about competition or publication or, you know, we didn't have enough money.
We have enough money, the students where I learned so much with them and from them and three of the four. And now we're two of the, yeah. Daisy. And we'll both work in indigenous communities. Now, Alexa is doing med school. Um, Hilary, I think is a neuro and Naomi is working in, um, looking at, you know, how could she can, she can decolonize her practice as a nurse on an acute ward in pediatrics.
Um, and the thing that's really struck me about doing it this way. You know, and then we shared it's publicly available here. It is, et cetera. And over the past year, I've gotten emails from all kinds of remote communities, including in New Zealand. Um, so for example, one interdisciplinary clinical team writ you know, over X number of weeks read each chapter of the guide.
So one chapter and then have clinical discussion. And what does that mean for our work here and how does it, so when you talk about knowledge, translation and impact of research, That's huge. Um, it's traveled everywhere. Like I, like, I don't even know. And we gave permission that if people wanted to link it on their websites, they could.
So this idea of an, and that's a term to decolonize knowledge. Um, and the thing that really struck me the most was, um, the consultants who participated in, in, in that work. And this is what I mean by, you know, Any kind of activism, you don't do it for yourself. You don't do it for, you know, it's part of your ethics.
It's part of your moral ground. And for the first time, After working in like, you know, oh, you work in your little corner, right. You work in your little corner and not everyone necessarily sees. And they were grappling with so much stuff like the cancellation fees and the systemic racism and the, how do we act?
Just so many layers there with the funding. And this is Nina. I have to stick a label. And what does this mean for my charting and all of the stuff and yeah. For them, it was a process of healing and we never really think of therapists meeting healing. Right. Um, but we work with so many people who are disenfranchised.
It doesn't matter where you work. You will see stigma, you will see discrimination, you will work with people who are disenfranchised, marginalized, made vulnerable, et cetera. And we can talk about it as compassion, fatigue, or burnout for therapist or vicarious trauma. I mean, we can use all of these fancy medical words.
Um, And I don't want to say that they're heroes, because none of them would like that in terms of, you know, I'm the hero narrative. Um, there's a lot of humility there. Um, but yeah, it's, it's interesting to think of the work that we do. Not just as rehabilitation, that the very different word of healing, I guess.
Um, so that's one that I'm super proud of and that we have a national practice network, the OT, occupational therapy, indigenous health network, um, as well as, uh, Jessica in the disability program services on Cree territory that are both reached out not to be like, okay, you're someone who's not going to just take from us because research has a huge extracted.
Kind of history, right? Like we take and what do we give back? So I, knowledge translation is, and participatory action research is so interesting, right? Because that tries to push against that, but still within a research structure, because I'm not primarily a researcher, I'm not stuck with those systems.
That's another piece, right? Like where do we choose to situate ourselves? Um, um, so yeah, so now I'm involved in. Participant, I don't even know where it's going to go. I'm fine with that. It's, it's quite, you know, like that, that, that comfort or need for certainty and predictability. Again, that's part of that, um, scientific procedural technical.
If then if I do this, then this will happen at, you know, most likely at this probability, right? Whereas this type of work is uncertain. It's relational, it's improvisational, it's spontaneous. It hits snags. It hurts. Hurts your heart. It's joyful. It's healing. It's um, personal growth. It's humanity. It's humane.
Um, yeah, so that's one that I'm super, super neat. And it's, and it's one that, um, the guide in terms of cultural safety, like we were talking about earlier, and maybe this will bring it back full circle. For, for those who are listening. Thanks for sticking it out. This far is very much the systemic struggles faced by occupational therapists and removing of course we have our responsibilities.
There's no doubt about it as individual OTs, but I also think it's really important for us to learn about and become aware of the systemic structural, including in our own profession. Ways that oppression and violence gets enacted. And for all those times where we feel like crap morally over something and then feel bad because we stayed silent or couldn't do anything about it or tried.
And the risks to us were, are pretty high, can be pretty high, right? Depending on if you're audited, if you're this, if you're that right. Um, I think. Being able to see that bigger picture and what it's like to live it, what the occupation of being an occupational therapist
experience of that with instructors that harm. That's what that guy tried to show. It was a particular context and whatnot, but apparently it's relatable a much broader than. So I think happy to share that it's like reading a book, it's like reading a novel. It's not like it's not like reading research.
Katie Caspero: So I appreciate that the title is called
stories of a pediatric rehabilitation practitioners within indigenous communities, a guide to becoming culturally and safer. That's the oneis from January, 2021.
Dr. Hiba Zafran: Fresh fresh, fresh, fresh off the press. Yeah. And hopefully more to come.
Katie Caspero: That's great. I love that.
That's really powerful. I feel like when I've done qualitative research, you know, you're doing it right. And when you have all those words of like, it hurts, it's uncomfortable. You know, not going the way you want it to go. Like that's when you know, you're probably doing it, right. If you're, if it's me, that's something you didn't get the right.
Dr. Hiba Zafran: I like the way I'm thinking of that. Just it's it's it's um, I guess the word for me is, is it just shows you that you are grappling with the complexity, which is the opposite of, you know, the original or regular scientific method of parsimony. You know, the most simple answer is probably the most. And again, right.
Um, but we're humans and we're messy and the more we're grappling with the complexity of it, then the more honest it is, I think. Yeah. And including that as part of the process, Absolutely. Well, this has been
very, very helpful and I think will be really inspiring to a lot of people. So thank you so much, Eva, for taking the time to talk through that and be able to provide some really concrete examples and just stories of your experience, um, and kind of how your work, um, is really, you know, working with people who, you know, you want to bring them, lift them up and be able to be the best occupational therapist.
Katie Caspero: So we appreciate all the work you're doing and I'm very inspired by you. So thank you,
Dr. Hiba Zafran: Katie. For my very first podcast activity. This is, this has been really, really neat. And, um, yeah, I I'm, I'm, I'm happy for people to reach out. I'm happy people to Google me, find me, reach out, ask questions. I have a tendency, um, to focus more on the, I I'm, I'm very practical in a lot of ways, but it is.
I do think theory's important and philosophy is important because if we don't have the right words to see the world around us and we just stay stuck. Right.