OT with Georgian Refugees

Tako Tavartkiladze is a Georgian Occupational Therapist and honorary member of OOFRAS. Tako was the deserved recipient of the 2006 OOFRAS scholarship to attend the World Federation Occupational Therapy Congress held in Sydney last year.

Here she talks about how occupational therapy is making a difference for Georgian Refugees (Internally Displaced People). 

Occupational therapy in Georgia
Georgia represents one of the post soviet developing countries, with the population approximately 5 million and with multiple ethnic minorities. On July 31, 1992, after regaining independence, Georgia was adopted in the UN organization as its 179th plenipotentiary member. The independence of Georgia was recognized by the Euro-Union countries. Since 1992 after armed conflicts in South Ossetia and Abkhazia about 300, 000 people were forced to fled from their home lands, they were accommodated in precarious conditions, mostly in collective centers often located in former hotels, schools, factories and hospitals, dependent on insufficient state budget.

Nowadays country has about 300, 000 Internally Displaced Persons (IDPs) living in different regions of Georgia, while some of them have temporary shelter. The unemployment rate is quiet high in the country. The most unprotected and vulnerable social risk groups are the people with disabilities in Georgia. According to the latest statistically data of the Ministry of Labour, Health and Social Affaires of Georgia there were about 9500 children with different kind of disabilities in 1996 (not officially counted). There still does not exist any updated statistical data.

The rehabilitation domain is very insufficient in Georgia. The treatment as well as educational system is mainly focused on medical model of care focusing more on “cure” and “normalization of people with disabilities”, giving less attention to the social model of disability. The field of occupational therapy as a part of health and social welfare is absolutely missing and wasn’t developed until 2001 in Georgia.

Development of new profession of occupational therapy was initiated by the Center for Child Neurology and Neurorehabilitation, with the partnership of European Network of Occupational Therapists in Higher Education (ENOTHE), the project “Introducing the Occupational Therapy in Georgia”, granted by CORDAID was launched for the period of 2001-2003). In September 2003 the project has been extended to the Higher Education institution in order to guarantee the continuation of occupational therapy education in Georgia. A new project was approved by the European Commission (Tempus programme) with the aim: ´´ Development of Occupational Therapy Education in Armenia and Georgia; Facilitate Participation of the Disabled in Armenia and Georgia (FaPaDAG) MP-JEP-23154-2002”.

I was educated as one of the first occupational therapists within this programme in Georgia, and later on became a co- teacher for the new EU funded project together with the international invited experts. At the moment I work for the State University as an occupational therapy teacher, educating the students on Bachelor level, at the same time I am employed by one of the international humanitarian organizations providing the protection and assistance for IDPs and refugees in Georgia, Norwegian Refugee Council (NRC).

My personal experience with marginalized populations
My involvement in the work with IDPs started from my field work education within the module on “Occupational Therapy with marginalized population” taught by Frank Kronenberg. The student project included drafting and designing the small-scale project with one of the deprived groups in Georgia from the occupational therapy perspective. It was first time when I got acquainted with the relevant actor in the field NRC. After that there have been many cases of sufficient and successful cooperation with the organization and IDP communities itself. Below I want to describe one project as a case where OT s worked on community level and empowered the IDP community.

Approximately 45 % of IDPs in Georgia inhibit in collective centers/camps (MRA, 2006) , in very restricted living conditions. Consequently it is very important to fit to the local context and with any type of initiative target the most vulnerable in the community. With the help of NRC the contact has been obtained with one of the collective centers which is located in Gori region (near the conflict zone), with IDPs from South Ossetia.

The key issue related to IDPs in Georgia is their multidimensional vulnerability (range of deprivation of their needs, lack of capacities, poverty, substandard housing, unemployment, and exclusion). In such a period of personal crisis as being uprooted from the original home, individuals may have difficulties to engage in the meaningful occupations, which influence their health and well-being. Occupational therapy believes the dynamic relationship between engaging in occupation and health.

Working with deprived groups in Georgia
The project “Empowering IDP Community in Collective Center” was implemented in 2006. The overall goal of the project was to use a partnership approach with the target group and make participatory engagement to identify their needs, priorities and to find out the problem solving strategies. several community meetings were organized. The contact was obtained with the civil society representatives with different local Nongovernmental Organizations-NGOs working in the region for and with displaced.
Afterwards the several meetings were conducted at the collective center with different age group community members to analyze the specific problems and outline the objectives.

As a result of the community mobilization, they stated one of the most important issues for them was a lack of entertainment opportunities for pre and school aged children living in collective centers. The particular collective center which was approached by us is quiet far from the city center; consequently children lack opportunities to be integrated in mainstream life and take part in everyday occupations relevant to their developmental stage, age, culture, and ethnicity. Based on these needs the community defined the main goal for the project: To construct a playground for children in the collective center. The main strategy for the project was partnership towards community empowering. With the support of “informal” community leader (a person who guided the whole community in decision making and problem solving) the group of parents-mainly mothers were mobilized. Together with parents project team developed the project proposal for the local municipality. The meeting with the head of municipal department of Gori region ended with handing over the construction materials for the playground. After this success mothers started to identify the internal local resources by means of labour force, second hand materials, any kind of relevant contribution for the construction work. In the period of six months the playground was constructed.

The main approach of the project was to empower and make a difference through community mobilization, that encouraged participation of beneficiaries in decision-making. Based on the gained experience we can claim that occupational therapists can offer a lot to deprived communities.

The outcomes of the project suggest how an occupational change is stimulated by the environmental change. This type of experience and knowledge should lead to an increased understanding in occupational therapy about occupational needs of displaced persons and can serve as a basis for population based intervention strategies in the future.


What does the University of Tiblisi (located in capital of Georgia) teach regarding occupational therapy and refugee work?
At the university we try to build up curriculum reflecting the local needs of the society. It is important to prepare the professional occupational therapists according to the demands of the labour market and local needs. The curriculum is developed in close partnership with the local and international educators. One of the emphases of the curriculum is community based work and occupational therapy.

First OT students on the University level were enrolled for the 2006-2007 academic year. I am teaching the module “occupational science and community based strategies in occupational therapy”. Students are encouraged to learn the theory, and at the same time design the first small-scale project aiming at visiting different organizations working with deprived groups and establishing the partnership with them in order to prepare the final report on the profile of the organization and also to introduce the occupational therapy to the relevant stakeholders. This is also one of the strategies for us in Georgia for the promotion of the profession and at the same time for preparing the grounds for further field work placements and professional practice. This is an example of the educational course which was piloted for this year for the first time, later on other modules in project based work are planned to be designed and launched at the university.

How can other OTs get involved in work like this in their own country?
The occupational therapists are equipped with the knowledge and skills to understand and facilitate human’s engagement in meaningful occupations, adapting the environment and adjusting to the individual’s or groups needs. I think that more involvement in this area is essential. First of all the area and field should be introduced more in the education, that is point of departure and how it can be strengthened further. My perspectives for the future is to initiative more education modules on this issue and provide students with the practical and theoretical skills to address the needs of our potential target group.
In addition to strengthening the education the professional networks like OOFRAS and others are extremely important to promote the profession in this area. There should be more promotion through professional conferences, annual thematic meeting, workshops which definitely will add the value to the domain.

1. As UNHCR (1951) defines IDPs are persons who are forced to leave their home and move to a new site within their home country.    2. Ministry of Refugees and Accommodation of Georgia (MRA, 2006), “National Strategy for Internally Displaced Persons in Georgia: Draft.”. Manuscript, Tbilisi, Georgia.

 Useful resources, books, articles for this work:

Algado, S. (2002) Occupational therapy Intervention with Children Survivors of War, Canadian Journal of Occupational Therapy , 69(4), 205-217

Algado, S., Gregory, J.M.R., & Egan, M. (1997). Spirituality in a refugee camp. Canadian Journal of Occupational Therapy, 64, 138-145     

Kronenberg, F., Simo Algado, S., Pollard, N. (2005), Occupational Therapy without Borders: Learning from the Spirit of Survivors, Elsevier-Churchill Livingstone, Oxford/UK.

Grady, A.P., (1995). Building inclusive community: A challenge for occupational therapy. American Journal of Occupational Therapy ,49 (4), 300-309.

Kronenberg, F. (1999) Street Children: Being and Becoming, Research report, Hogeschool Limburg, the Netherlands, 1-42.
Schisler, A.M. & Polatajko, H.J. (2002). The individual as mediator of the person-occupation-environment interaction: Learning from the experience of refugees. American Journal of Occupational Therapy, 9, 82-92.

Smith, H. C. (2005) Feel the fear and do it anyway: Meeting the occupational needs of refugees and people seeking asylum; British Journal of Occupational Therapy; 68 (10), 474-476.

Townsend, E., & Wilcock, A. (2004). Occupational justice and client-centered practice: A dialogue in progress. Canadian Journal of Occupational Therapy, 71, 75-87.

Sumbadze, N., Tarkhan-Mouravi, G. 2003. “Working Paper on IDP Vulnerability and Economic Self-Reliance.” UNDP. Tbilisi, Georgia.

United Nations Office for the Coordination of Humanitarian Affaires (OCHA), Situation report on Georgia for November, 2004. from www.undp.org.ge 
   
Whiteford, G.E. (1997). Occupational Deprivation and incarceration. Journal of Occupational Science, 4, 126-130.

Whiteford, G.E. (2000). Occupational Deprivation: Global Challenge in the New Millennium. British Journal of Occupational Therapy, 63, 200-204.

Whiteford, G.E. (2005).Understanding the occupational deprivation of refugees: A case study from Kosovo. Canadian Journal of Occupational Therapy, 72, 78-88.

Wilcock, A. (1998 a). An occupational perspective of health. Thorofare: Slack Inc.

Yau., M, K., (1997), The impact of refugee resettlement on Southern Asian adolescents and young adults: implication for occupational therapists, Occupational Therapy International, 4(1), 1-16.