What does it take to be an occupational therapist in Malaysia?

I often come across this question, particularly from (1) occupational therapy colleagues abroad who would be keen to experience working and living in this hot tropical country of mine. (2) Malaysians who have heard about this exciting new field and are looking at it as an alternative to medicine / dentistry / pharmacy (which everybody applies for).

The great thing is that most occupational therapy work ends at about 5-6pm, when it's less hot and you can go enjoy the pool or the beach straight after. (I spend plenty of time in the pool myself, living in Kuala Lumpur most of the time. I would like to spend more time at the beach, but that shall be my reward when I move back to Penang for good in a few years time.) No on-call time but some occupational therapists may work weekends (especially those who are self-employed like me, but I work all the time. Don't compare my work schedule to a typical Malaysian occupational therapist's.)

For occupational therapists from other countries who want to work here (or for Malaysians who studied abroad).

Here's the thing, occupational therapy in Malaysia is not (yet) a licensed profession. This means that there is a lot of freedom as far as practice is concerned. It's also how I get to work on some pretty awesome innovations to my practice that may not necessarily be allowed in developed countries (out of caution, and the fear of being sued) but which could contribute to better outcomes for clients. It also means more opportunities for accelerated professional growth as fresh graduates are often thrown into the deep end with no (or very little) supervision and they have to swim fast and well - for the sake of their clients. It is not uncommon for a fresh graduate to have to be in charge of setting up their own department here, due to the lack of experienced manpower.

There's a downside to this however, as it also means that fresh graduates who cannot meet the standards of care risk jeopardising the well-being of clients. Fortunately, I think many of our fresh graduates are aware of their responsibility and therefore are careful to proceed with caution. That's why our profession grows kind of slowly in Malaysia. :) another downside is that any body can call themselves an occupational therapist (or as is typically the case, claim that they are providing occupational therapy services) and get away with it - we can't take legal action against them, we can't do anything about it besides keep the public informed (about how to recognise good and bad practices, how to know whether their occupational therapy is working for them, etc). This too should be seen as part of the learning curve for an occupational therapist in Malaysia - public outreach, a very important skill.

Anyways, here's what you can do to qualify as an occupational therapist in Malaysia (if you are not one already).

Diploma in Occupational Therapy

Government institution courses offered by the Ministry of Health and UiTM (which takes in applicants according to race, so if you're not bumiputera your chances of qualifying for this particular course are pretty much nil). Offered in very few private colleges - maybe 2? - due to lack of manpower (not enough qualified teachers). This is typically a 3-year course.

Bachelor's degree in Occupational Therapy

Offered by only two government institutions (UiTM and Universiti Kebangsaan Malaysia - the National University of Malaysia, which is where I studied) and one private institution (tuition fees are about RM80K for this one,) The Bachelor's degree is a 4 year course with honours. Everybody has to do a thesis at their 4th year and everybody gets an honours.

Upgrading from diploma to bachelor's degree

Choices are very limited and I could write a whole blog post about this. However, if you're reading this and you're representing a foreign university - WE NEED YOUR HELP. An affordable top-up course for our diploma holders would be really appreciated! (I have a personal vested interest in this because Ter Fu is a DipOT by virtue of the course he got into - for his intellect and level of knowledge, I think he deserves a degree - and can't find suitable options to upgrade, so if you've got ideas, please contact us!) The Malaysian system doesn't allow for upgrading from Diploma to Masters - even though I know it's possible and that universities from abroad accept diploma students for their Masters courses, but it won't show in the pay grades which kind of negates the purpose of investing in higher education (for many people anyways) if you can't make the returns to pay for it.

My advice to Malaysian occupational therapy students is typically, make that time in your studies count (and that would be another upcoming blog post - why and how to make the time in your studies count.) It makes all the difference in terms of launching a successful career in an undeveloped market like this, i.e. when you're out working, you won't have as much access to freely available resources anymore! I was very fortunate to have the kind assistance of many occupational therapists and students worldwide who made all the difference to my studies. More on that later!

How do you know whether your occupational therapy is working?

Unlike other health professions, occupational therapy is a process, not a magic bullet that can be solved in a set number of sessions. 

In my experience, if you're going through occupational therapy, give yourself 3 months. If you actually follow your therapists' recommendations and don't see any changes in 3 months, then only decide that it isn't working for you. Sometimes there are changes, significant changes but not very big. The effects are compounded over time, meaning the incremental changes over time can have a very major effect if you keep at it for long enough.

Gradually as the amount of health-promoting habits a person has increases, the amount of change would also increase. I have had clients who give up on the occupational therapy process too soon, and therefore very sadly could not reap the full benefits of occupational therapy. That's why these days I get my clients to commit to a two month package (but I tell them beforehand to give themselves a minimum of at least 3 months) rather than a pay per session basis.

If you're an occupational therapist and you notice that you come across the same issue as I had, of clients giving up on themselves or their therapy too soon, it helps to set the expectations beforehand at the very first meet itself. My first consultations are always free (to give clients a sneak peek of what to expect from my service) and it's typically the second meet where we would discuss things like therapy boundaries and expectations. Discussing therapy boundaries and expectations is an important part of the occupational therapy process, and it is of utmost importance that our clients understand that occupational therapy is a process, NOT a magic bullet.

How to convince the stubborn unhealthy person to develop healthy habits.

In my occupational therapy work, I often come across family members who request for my help in order to "convince" a loved one they care about to stop certain high-risk habits and to start certain healthy ones. If you're going through a similar situation, this post is for you.

1. Recognise that you can't convince people.

You can only give them the information they need in order to be able to make an informed decision. In occupational therapy we practice client-centered practice, this means that the client is in the position to make their own decisions, we give them recommendations and options, but at the end of the day, the client is the one responsible for making their own choices and living with the consequences.

2. Read these books. These books are on my recommended reading list for clients and caregivers. Occupational therapists believe cooperation between the client and their family members is important to ensure a good outcome. Every time I find myself in a situation involving client-caregiver relationship dynamics, the first thing I do is prescribe these books for reading. 

One of my occupational therapy for mental health clients is just only on her first book, but her quality of life has improved significantly that she has already reduced her medication intake, just by reading and applying what is taught in these books.

3. People don't care how much you know until they know how much you care.

How are you conveying your message? Deep down inside, your stubborn family member knows you love them - but at that moment in time, do they feel like you're a nag or or are they able to genuinely able to feel your love and care? If you read the books mentioned above, you'll be able to learn the different ways different people with different personality types and communication styles feel love and care, and be able to pass the message on to them in a way that is acceptable to them.

4. Old habits die hard, unless there is something worth changing for.

My parents engage in activites that are meaningful and purposeful to them after retirement, as opposed to sitting in front of a TV all day as most old people would. They are also extremely healthy. If you have a loved one who finds it very difficult to change their high risk habits to healthy ones - perhaps you may want to ask yourself, what's the prize for the healthy "price" they feel have to pay?

Last weekend I gave an occupational therapy consultation to the family of an elderly gentleman whose diabetes and high blood pressure diagnosis spanned 20 years and his family wanted him to change his habits. They also stopped him from leaving the house because if he did he would engage in habits that weren't good for him. Even before I talked about changing how he ate and what he ate, the first thing I talked about to him after doing an analysis of his lifestyle was that he needed to explore new activities that gave purpose and meaning to life.

"If you're 60 years old now, and average life expectacy is 70-80, that means you have another 10-20 years to live. Do you want to spend your next 10-20 years watching TV at home? If your next 10-20 years is to be spent watching TV at home, then of course you don't need to be healthy. How would you like to spend your next 10-20 years?"

If they have something significant to do (or a role to play) in the next 10-20 years, which requires a healthy body in order to do it properly, then don't you think it would be worth making some changes to one's habits in order to do that?

So before you want to get your stubborn loved one to change their habits:

1. - ask yourself, do they have something that tugs at their heartstrings enough in order for them to want to change their habits and get out of the comfort zone for? Are they aware of it?

2. - ask yourself again, have I earned the right to tell them to change? (Just because you are their family member or you think you care for them, doesn't mean they grant you this right.) Have I earned their trust? Do I show them (in the way that they want to be cared for) that I care for them?

Too many people are angry at their loved ones for not changing their habits. So long as you continue to convey the message in an angry way and continue to be angry with them for not changing, then they will continue not to change. Change your approach, and soon you'll see changes in them too.

What can Malaysian occupational therapists contribute to occupational therapy knowledge internationally?

I think with our high percentage of Muslim occupational therapists, society where religion stills plays a very important role in our everyday lives, and reasonably good skills in English (we're not perfect, but we do have a higher level of English skills than many other Asian countries), Malaysian occupational therapists actually have the opportunity to play a very important role in the development of culturally relevant occupational therapy for Muslims around the world.

With Islam as the second largest world religion, but with most occupational therapy interventions more slanted towards the Western way of living, we can see that occupational therapy that is compliant with the Muslim way of life is quite under-served and there is much that Malaysian occupational therapists can contribute in the development of this area, not just in developing interventions, but also in terms of educating non-Muslim occupational therapists around the world who have Muslim clients to serve.

Personally, I am not a Muslim occupational therapist. I'm actually Buddhist. But I am spearheading some efforts to develop culturally relevant occupational therapy for Chinese communities (alongside occupational therapist colleagues from China, Hong Kong, Taiwan, Singapore, and of course - Malaysia). With 500, 000, 000 (500 million! Wow!) overseas Chinese and 1.35 billion people living inside China itself (20% of the world's population!), all sharing a common ethnic, cultural background with daily living practices very much unique to their Confucian culture, the dominance of Western-based occupational therapy practice (and subsequent lack of culturally relevant occupational therapy for this population) means large numbers of people unable to benefit fully from what occupational therapy has to offer.

If we don't do something about this issue, who would we expect to take on the responsibility? This is the same question I ask people when they ask me why I choose to remain in this country to develop the occupational therapy profession when I could very easily get a job elsewhere - if not me, who else?

First Post!

After years of procrastination, I finally get round to setting up a blog where I actually write posts. Why have I never set up a blog all this while?

1. I didn't think I would be able to maintain the regular updates.
2. I thought too much (what if I get a more professional site later, how would I be able to maintain it? I want to be able to optimise the blog to be able to generate income from the beginning but how do I do that?, blah blah blah.)

Finally, I just decided to get around to it!



Why?

1. There are very minimal resources about occupational therapy in Asia and Malaysia. If we don't do something, who are we waiting for?
2. I keep posting things on Facebook and losing them. I need a better archive.

Hopefully I'll be able to keep this occupational therapy blog afloat long enough for it to play a significant role in online occupational therapy resources, particularly about occupational therapy practice in Malaysia and Asia in general. Onwards and upwards!