Professional Documents
Culture Documents
Supporting Evidence
Summary
References
Theoretical Base
Function/Dysfunction Continua
Application to Practice
Case Examples
Supporting Evidence
References
Theoretical Base
Function/Dysfunction Continua
Application to Practice
Case Examples
Supporting Evidence
Summary
References
Chapter 15 A Strength-based Frame of Reference for Autistic Individuals
Theoretical Base
Function/Dysfunction Continua
Application to Practice
Case Examples
Supporting Evidence
References
Chapter 16 A Frame of Reference for School-Aged Children with Anxiety and Depression
Theoretical Base
Function/Dysfunction Continua
Application to Practice
Case Example
Supporting Evidence
Summary
References
Part 4 Summary
References
Index
Copyright
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Printed in China
Names: Kramer, Paula, editor. | Hinojosa, Jim, editor. | Howe, Tsu-Hsin, editor.
Title: Frames of reference for pediatric occupational therapy / [edited by] Paula Kramer, Jim
Hinojosa, Tsu-Hsin Howe.
Description: Fourth edition. | Philadelphia : Wolters Kluwer, [2020] | Includes bibliographical
references and index.
Identifiers: LCCN 2018051893 | ISBN 9781496395061 (hardback)
Subjects: | MESH: Occupational Therapy—methods | Disabled Children—rehabilitation |
Developmental Disabilities—rehabilitation | Child Development | Infant | Child |
Adolescent
Classification: LCC RJ53.O25 | NLM WS 370 | DDC 615.8/515—dc23 LC record available at
https://lccn.loc.gov/2018051893
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Dedication
This book is dedicated to Jim Hinojosa, our beloved friend and colleague. He left us much too soon.
Furthermore, we dedicate this book to the children, families, and colleagues we have worked with and
who have changed our lives and perspectives. We also recognize our own families who have supported
us throughout our careers and have helped to make this book possible.
Ultimately, this book is dedicated to the children whose lives may be changed by this book.
Contributors
Annie Baltazar-Mori, OTD, OTR/L, Occupational Therapist/CEO, playSense, Los Angeles,
California
Susan M. Cahill, PhD, OTR/L, FAOTA, Program Director and Associate Professor,
Occupational Therapy, Lewis University, Romeoville, Illinois
Cheryl Ann Colangelo, MS, OT, Instructor, Programs in Occupational Therapy, Columbia
University Medical Center, New York, NY
Craig Greber, B Occ Thy, BHMD (Ed), PhD, Assistant Professor, Discipline of
Occupational Therapy, Faculty of Health, University of Canberra, Canberra, Australia
Jim Hinojosa, PhD, OT, BCP, FAOTA, Professor Emeritus, Department of Occupational
Therapy, Steinhardt School of Culture, Education, and Human Development, New York
University, New York, New York
Margaret Kaplan, PhD, OTR/L, Associate Dean, College of Health Related Professions,
State University of New York, Downstate Medical Center, Brooklyn, New York
Kristie Patten Koenig, PhD, OT/L,FAOTA, Associate Professor and Chair, Occupational
Therapy, New York University, New York, New York
Laurette Joan Olson, PhD, OTR/L, FAOTA, Professor and Program Director, Graduate
Occupational Therapy Program, School of Arts and Science, Iona College, New Rochelle, New
York
Susanne Smith Roley, OTD, OTR/L, FAOTA, Co-Founder, Collaborative for Leadership in
Ayres Sensory Integration (CLASI), Aliso Viejo, California
Karen Roston, MA, DPS, OTR/L, Private Practice, New York, New York
Colleen M. Schneck, ScD, OTR/L, FAOTA, Professor and Department Chair, Department
of Occupational Science and Occupational Therapy, College of Health Sciences, Richmond,
Kentucky
Sarah A. Schoen, PhD, OTR/L, Director of Research, STAR Institute for Sensory Processing
Disorder, Greenwood Village, CO, Associate Professor, Rocky Mountain University of Health
Professions, Provo, Utah
Mary Shea, MA, OTR, ATP, Clinic Manager, Outpatient Wheelchair Services, Kessler
Institute for Rehabilitation, West Orange, New Jersey
Virginia Spielmann, MS, OT, Executive Director, STAR Institute for SPD, Greenwood
Village, Colorado
Jenny Ziviani, PhD, DipOT, Professor in Occupational Therapy, School of Health and
Rehabilitation Sciences, The University of Queensland,, Queensland, Australia
Foreword
In the fourth edition of Frames of Reference in Pediatric Occupational
Therapy, Drs. Paula Kramer, Jim Hinojosa, and Tsu-Hsin Howe have
included updated and additional frames of reference that are in line
with current theory and trends in occupational therapy. Additionally,
summaries of the most relevant and available research evidence that
support each frame of reference are provided.
My formal introduction to the frame of reference occurred when I
was a graduate student at New York University and was educated
and challenged by Dr. Anne Mosey, its originator. There are other
ways of describing theory-driven and evidence-based guidelines to
practice that resonate with the original conceptualization of the frame
of reference. What is most important is that we as a profession
articulate and disseminate sound rationale, clear guidelines for
evaluation and intervention planning and evidence for multiple
stakeholders to be able to make decisions about interventions,
programs, and services we provide, develop, and investigate in
occupational therapy.
My own work in outcome measurement and intervention
development and testing has taught me that the effort involved in
developing and testing frames of reference is no easy task and
requires ongoing refinement to address the needs of our consumers at
multiple levels: individual, family, community, and population. As
evidence grows in the form of research and clinical and consumer
knowledge and experiences along with new health and occupational
needs emerge in society, so will changes in our guidelines for practice.
Stated simply, the structure and function of the frame of reference
provides the opportunity to make these necessary changes. It
identifies what needs to be done (e.g., key activities to promote
purported outcomes), whether purported outcomes were achieved,
what needs to be modified, and when other frames of reference might
be used in combination or as an alternative.
Thus, the fourth edition of Frames of Reference in Pediatric
Occupational Therapy is an important textbook that can assist
students, practitioners, and researchers who want to apply and
contribute to the body of knowledge and evidence of occupational
therapy and have an impact on the lives of children and youth with a
range of conditions and their loved ones. The structure and function
of each of the selected frames of reference is well described to make it
easy for the reader to learn, use in practice, and refer to when needed.
The case examples within each chapter enhance further
understanding of the clinical reasoning that is needed for application
in real-life practice. Complex concepts are clearly explained making
the textbook accessible to multiple readers, including consumers,
interdisciplinary professionals (practitioners, educators, and
researchers), funders, and policymakers. All authors should be
commended for their thoughtful and excellent work here!
Louis Pasteur
As society changes, a profession must continue to change and develop to remain relevant.
Since we wrote the first edition of this text, many changes have occurred. Theories have
evolved, changed, and adapted, and the types of clients and services that we encounter have
changed. Subsequently, our practice has been supported and modified by published research.
We still strongly believe that practice needs to be based on and guided by theory, maybe even
more now than before. We cannot rely on habit or intuition to lead us. The frame of reference
provides an effective vehicle for putting theoretical information into practice. It serves as a
blueprint for occupational therapists who work in pediatrics. So it seemed that this time, there
was no question as to whether a fourth edition was needed. We knew it was needed, and we
knew more that we had to address changing theories and areas of practice that were not
covered in the previous edition. To remain relevant, this book needed to evolve as well and
include new knowledge that is being used in practice.
As before, we relied on feedback from users of the text and other expert reviewers, to
reorganize and update the new edition. All of the chapters have been updated to reflect
changes in theory and practice, and new material has been added. The first part holds critical
background information for current pediatric practice. The structure of the frame of reference
has been put up front as that remains the heart of the text. The second section contains the
various frames of reference. A final chapter presents important issues in applying frames of
reference.
This second edition is fully updated to provide the most up-to-date information on new
knowledge, new diseases, and new guidelines for diagnosis. In addition, many images have
been updated, and two new features are included.
This fourth edition continues to focus on the importance of occupation, and all of the frames
of reference have been revised to include examples that relate to the importance of occupation
and active involvement in a meaningful life. This edition includes three new frames of
references, including the STAR frame of reference for working with children with sensory
processing disorders, a frame of reference for working with children with anxiety and
depression, and a strength-based frame of reference for working with adolescents with
autism. A major thrust of this revision was the updating of material in all chapters. Content
was overhauled to reflect changes in theory and practice. In addition, all frames of reference
have a new section called Supporting Evidence that reflects the importance of research to
practice.
As with previous editions, this fourth edition is meant to be an effective tool for teaching
pediatrics to entry-level students; however, it can be equally beneficial for therapists who
want to enhance the use of theory in their practice and for those who are seeking new and
updated approaches to interventions. The book continues to provide pediatric information
organized through the structure of frames of reference.
For this edition, we continued to use the language of the World Health Organization’s
International Classification of Functioning, Disability, and Health (ICF). Incorporation of ICF
language broadens the appeal of the book. This language resulted in an emphasis on the
importance of the child’s ability to participate in meaningful activities of life (occupations). It
is our hope that both new and experienced therapists will use this text to bring new
approaches into their practice and update their knowledge of their favorite frames of
reference. We hope that practice never becomes habit and is continually updated through the
use of current theory.
Paula Kramer, Ph.D., OTR, FAOTA
Jim Hinojosa, Ph.D., OT, FAOTA
Tsu-Hsin Howe, Ph.D., OTR, FAOTA
Acknowledgments
We are very grateful that this book has been so well received that we
have been asked to write a fourth edition. While writing a book is a lot
of work, in many ways, it is a labor of love because we strongly
believe in the critical role that theory plays in practice. It is our goal
that this edition contains new knowledge and makes a significant
contribution to pediatric practice. All the chapters that appeared in
previous editions have been updated, and we have added new
chapters that we believe are relevant to current practice.
Furthermore, we have added a section to each frame of reference on
supporting evidence to indicate the state of the research related to the
frame of reference. We hope this fourth edition will meet the needs of
those interested in pediatric occupational therapy practice and will
enrich the current literature of our profession.
Just as this book was going into press, Jim Hinojosa passed away. We
mourn his loss and are grateful for all the time we spent with him. He
was a very dear friend and colleague, and will be deeply missed. His
imprint is on every page of this book, and through it his spirit will live
on.
It is also important to acknowledge the addition of a third author, Dr.
Tsu-Hsin Howe, who provided outstanding skill in writing, editing,
and revising many of the chapters. Her knowledge of theory and
practice has provided a significant contribution to this edition.
There are many people to thank who helped us, directly or indirectly,
to make this new edition possible. First and foremost, we thank our
parents, as they are critical to our development and success. Our
families have always been there for us, providing love, support, and
encouragement, even when writing took time away from them,
notably, David and Andrew Hunt, Steven A. Smith, and Ching-Fan
Sheu. Dr. Anne Cronin Mosey has strongly influenced all of our
thinking and professional development. We mourn her passing and
gratefully recognize her contribution to us personally and to the body
of knowledge of occupational therapy.
A special thanks to all the authors who contributed to this book, and
to their spouses, significant others, families, and friends who were
supportive to them and thus assisted them in producing such fine
work. We are fortunate that they consider us to be their friends as well
as their colleagues. Our colleagues at the University of the Sciences
and New York University have always provided us with
encouragement, support, and feedback throughout this project. We
are very appreciative of the efforts of the entire team at Lippincott
Williams & Wilkins who have been tremendous supporters of this
book, especially Michael Noble, Matt Hauber, Amy Milhoven, and
Jeremiah Kiely. We are grateful to our students for their questions and
observations, which have always stimulated our growth. Their
feedback as students and therapists have continually contributed to
our development and shown us that this book is valuable and well
used.
The pictures in this book are critical to illustrating the text. Numerous
families and colleagues contributed photographs, and we are very
grateful that they have allowed their children to appear in this book.
In particular, three families have their pictures sprinkled throughout
the book, the Benham family, the Hendrickson/Capaci/Williams
family, and the Hoffman family. All the photographs make the text
much richer.
Finally, we are indebted to our colleagues who continue to develop
the art and science of pediatric occupational therapy.
PA R T 1
Foundations Of Pediatric Practice
OUTLINE
Theoretical Base
When therapists begin to use a new frame of reference, they should
be certain to understand the theoretical base and its component parts.
The theoretical base sets the stage for the entire frame of reference. It
is usually the most complex and abstract section in the frame of
reference, but it is critical to understand it to move from theory to
implementation of the frame of reference into practice. In addition, the
theoretical base includes both constant and dynamic theoretical
information. Constant theoretical information describes static
phenomena that define and describe the relationship between
phenomena. Dynamic theoretical information describes how change
takes place; how it may be initiated, inhibited, or maintained; and
how the condition of homeostasis is sustained.
The theoretical base broadly delineates the areas of concern of the
frame of reference within the broader context of occupational therapy.
The theoretical base also identifies the various theories on which the
frame of reference is based. It identifies all assumptions being made,
and it identifies the major concepts and defines them.
There usually is a design in the theoretical base that describes how
each of the parts fits together to form a whole. When learning a frame
of reference, it is important to understand the theoretical base design
or the way in which it is organized. The way that the theoretical base
is organized should be reflected in all subsequent parts of the frame of
reference. The key components of the theoretical base are
assumptions, concepts, definitions, and theoretical postulates. For
example, if the theoretical base presents concepts in a particular order,
as if one flows from the next, then that order should be reflected in all
other parts of the frame of reference. This format enables the therapist
to understand the design of the frame of reference and follow the
same order in the application of the theoretical base to intervention.
This again highlights the importance of the theoretical base.
Adequacy of Theory for Frames of Reference
When choosing a theory to support a guideline for intervention,
therapists must examine the suitability of the theory by examining the
adequacy of concepts, definitions, and postulates of the theory. As for
the concepts used in the theory, therapists need to determine whether
a theory’s concepts are defined at an abstract level and need to
examine how each individual concept is used throughout the theory.
An important aspect of a theory is consistency of the concept label or
how the theorist refers to the concept (set of phenomena) in each
instance throughout the theory. Does the theorist use the same label
(concept) whenever he or she refers to the particular set of
phenomena? For a theory to have concept label consistency, the
answer must be yes. In scientific writing, as opposed to creative
writing, one uses the same label for the set of phenomena throughout
the theory. Thus, each concept has a label that captures a specific set of
phenomena, and this label must be used consistently throughout the
theory. To assess the definitions of concepts, the level at which a
concept is defined needs to be evaluated. This is evaluated because, in
a theory, the definition of a concept must be defined at the abstract
level without referring to a specific object, instance, or circumstance.
After examining the adequacy of the definitions within the theory, we
consider the structure of the theory.
The critical component in the structure of the theory is its
postulates. Postulates give meaning to theoretical information. To be
an acceptable postulate, the relationship between concepts must be
stated in a clear and concise manner, so it will easily be tested.
Without postulates, concepts would contribute little to the description
of a set of phenomena.
Theoretical Base: Making Contact With Persons of the Opposite Sex as an Adolescent
For those individuals who are heterosexually oriented, interest in
developing relationships with the opposite sex generally begins around the
preadolescent or early adolescent stage of development. It is normal and
natural in early adolescence to begin to get interested in the opposite sex. It is
somewhat difficult and uncomfortable, however, to make initial contact with
an unknown person of the opposite sex. As one grows older, one usually finds
it easier to initiate and maintain contacts with members of the opposite sex.
Furthermore, as one gains more experience relating to the opposite sex, one
becomes more interested in and comfortable with the idea of choosing a life
mate. Persons become more focused about who they are and what they want,
expect, and need from others.
The theoretical base of this frame of reference is drawn from several
developmental theorists, including Blos (1962), Erikson (1968, 1982), Rogers
(1961), and Elkind (1967). Erikson (1968) describes development in terms of
stages. The stages during preadolescence and early adolescence are industry
versus inferiority and self-identity versus role diffusion. Blos (1962) states
that at the preadolescent stage, it is normal to begin to get interested in the
opposite sex, although this interest may be expressed first in an inappropriate
and somewhat hostile manner; however, this is still a means of making
contact. Erikson (1968, 1982) further states that the beginning of interest in
the opposite sex is a preparatory step toward young adulthood (intimacy and
solidarity versus isolation), when one becomes involved in choosing a life
partner. Elkind (1967) reinforces the concept that it is initially difficult to
make contact with the opposite sex for the adolescent because he or she feels
self-conscious. He states that adolescents presume that everyone around them
is an “imaginary audience” and that they are the center of attention.
Adolescents believe that everyone is looking at them. This presents some
conflict to the preadolescent or early adolescent. They want to make contact
with the opposite sex, and yet it is difficult for them. Rogers’ (1961)
contribution is his theories of interpersonal communication and the ability to
establish relationships. All these theories take the position that making
contact with the opposite sex is normal and natural.
There are various ways that people begin to make contact with the opposite
sex during this stage of life. One way is generally referred to as flirting.
Flirting is an attempt to get the attention of someone, usually a person that
you do not know well, and generally has an underlying sexual connotation. It
involves making eye contact, smiling, acting in a coquettish manner, and
making actual contact in a socially appropriate way.
Flirting is frequently used to determine if the other party has any interest
in the person doing the flirting. Making eye contact and smiling at the same
time is an acceptable way of flirting. In many situations, flirting is a socially
appropriate way of making contact with someone of the opposite sex. In some
situations, however, it may be seen as forward or socially inappropriate
behavior. Socially appropriate behavior refers to actions that are acceptable in
a public situation based on age, sociocultural values, and norms.
Assumptions
Assumptions are ideas that are held to be true and are not
questioned or tested in any way. In other words, they are basic beliefs.
All theories have assumptions. If the theoretical base draws from
several theories, then all the assumptions made must be accepted by
all those theories and are not in conflict with each other. Assumptions
in the theoretical base of Making Contact with Persons of the Opposite
Sex as an Adolescent are as follows:
Concepts
The concept is abstract and does not refer to a single phenomenon
(e.g., an object, a person, or an event). Because the concept is abstract,
you can include another individual phenomenon into the concept if it
shares the defining characteristics. Concepts selected from the theories
must represent the concern and scope of the frame of reference. These
concepts are used consistently with the same definitions across all
sections of the frame of reference. Concepts are labels of sets of
phenomena.
It is important to remember that the use of concept in everyday
language is very different from its scientific use. In everyday language
it is used to convey an idea or an impression, whereas in science it is
formally defined to refer to an abstract description of characteristics
that go together around a set of phenomena.
A concept can be categorized by its tangible characteristics, the
manner in which it was defined, or its conceptual level. Furthermore,
a concept may belong to more than one category. Categorization of
the concepts is the first step to understanding how the theory is
structured. Concepts can be categorized based on whether or not they
have tangible or directly observable characteristics. For example, both
flirting and behaving in a socially appropriate way are simple
concepts. A simple concept is one that can be readily observed by
visual, auditory, kinesthetic, or tactile sensation.
While not included in this example, other theoretical bases may use
constructs. Constructs are not readily observable and are not based on
directly observable phenomenon. They are defined by one’s
observations. In the occupational therapy, constructs often refer to
emotional states, such as anxiety or depression. Some theoretical bases
may include a specific type of constructs labeled “hypothetical
constructs.” Hypothetical constructs differ from constructs in that
hypothetical constructs are based on the originator’s ideas or thoughts
and are used to develop theories beyond the observable world. For
example, Elkind’s (1967) imaginary audience is a hypothetical
construct based on his observations with adolescents.
Concepts can also be categorized according to their relative order. A
superordinate concept is at a higher conceptual level than another
concept. A subordinate concept is at a lower conceptual level than
another concept. When concepts are neither superordinate nor
subordinate to each other, they are at the same conceptual level.
Concepts in the theoretical base of Making Contact With Persons of
the Opposite Sex as an Adolescent are as follows:
Concept: flirting
Concept: behaving in a socially appropriate way
I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.