Foreword

M. Carolyn Baum

Each of us has had a chance meeting that has had a major impact on our life. I
had such an experience in September 2003 in the San Francisco airport. A
young man came up to me and said ‘Dr Baum, may I have the privilege of
accompanying you to Singapore?’ That young man was Michael Iwama and it
was serendipity that we were scheduled on the same plane en route to Singapore
for the 3rd Asia Pacific Occupational Therapy Congress.

For the next 16 hours I was captivated by a young man with commitment to the
profession and its history. He had a knowledge of theory, social context and
culture and a passion to help us all to understand and then implement programs
and services that cross cultural boundaries. His message was that because
we focus on the daily lives of people we must understand and respect not only
the culture of nations but also the cultural diversity within the boundaries of our
own communities and organizations in which people live and work. My life was
changed, as my view of occupational therapy in the world was expanded and I
saw a young scholar who would make a contribution not only to our profession
but to the world.
In this book Dr Iwama challenges us to expand our minds and actions beyond
our own social boundaries to those that our clients find meaningful. He asks us
to look at the lived and socially constructed experiences of the people we serve
rather than hold on to those with which we are comfortable.

This is a very important book for both teachers and students of occupational
therapy. Dr Iwama helps us define the culture of occupational therapy by
exploring its theory, constructs and principles. He challenges us to look beyond
our own knowledge and experience and to place that knowledge in the context
in which it is applied – in the lives of people as they address problems that limit
their daily activities. He supports the reader as they accept this challenge. As he
gives life to the concepts, he gives us ideas to discuss and, most importantly, he vii
 gives us the tools to use to approach a greater understanding of our culture of
occupational therapy and the social and cultural context of care.

Most of the occupational therapy models in use today, including The Person-
Environment-Occupational-Performance Model developed by my colleague
Charles Christiansen and me, are informed by common experience situated in
the Western world. We cannot assume that these models are universally appro-
Foreword

priate as we see occupational therapy continue its growth around the world
(currently there are 60 member countries in the World Federation of Occupational
Therapists, many in developing countries). There is a specific need to have
contemporary models to meet diverse social contexts.

The Kawa model is an exemplar of how occupational therapy can fit the people
it will serve. Although I was introduced to the model from the Japanese per-
spective I find myself thinking a lot about it because of the way the Kawa model
encourages us to see disability and chronic disease as a collective experience. It
asks us to view the self as a number of elements that cannot be separated.
These elements include life circumstances, strengths and limitations and life flow,
which includes goals, relationships and health.

I grew up in a faming community in Kansas. Recently I was explaining what

occupational therapists do to a friend from my home town. Because he is a
farmer and very passionate about his land I used the Kawa model to explain how
rocks and roots of trees can block the flow of a stream. When we discussed what
those blocks to the stream might be I explained to him what the OT could do
to help the person ‘restore the flow of the stream’. He was very interested in
what I do and he understood it because I explained it in a context that was
understandable to him.

I want to share one more experience that shows the strength of the Kawa model.
Recently I got a call from the Dean of Medicine’s office asking if I could speak to
a visitor from Japan. He was planning a visit by Japanese medical students to
learn about advances in Western medicine. He arrived expecting to talk about
physical therapy and when I told him I was director of occupational therapy he
looked as if he wanted to leave, saying that he wanted his students to learn about
advances in physical rehabilitation. I pointed out that some of the most important
work in the development of contemporary rehabilitation is being developed by
occupational therapists in Japan and told him a little about the Kawa model.

He mentioned that Kawa means river in Japanese and I explained that the river
serves as a metaphor to let the patient (he was a doctor so I used the term
patient) share the experience that is causing the difficulties that require rehabili-
tation. We then went on to speak about why occupational therapy is essential
to helping people overcome problems that threaten their health and well-being.
viii
I told him about our innovative community programs and he then decided that he
definitely wanted his students to learn about occupational therapy during their
visit to the medical school. He also asked if he could take away some information
about the Kawa model, which I was very pleased to provide.

We need tools to work with those who need our services and to communicate
our uniqueness to others. I believe the Kawa model can help us focus our work
on individuals in the context of their lives.

Dr Iwama’s book will give us knowledge and it challenges us to think about the
culture of our profession as well as the culture of those with whom we work. It will
also help us gain insight into the cultures of organizations and groups.

This book should form the basis of theory courses for students around the world
– the discussions that will ensue will go a long way to helping us understand that
in fact the world is flat and that occupational therapists all over the world can
learn from each other because we share a culture of occupational therapy. The
book will also help us all honor the cultures of the people we serve as we seek to
improve their everyday lives.

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