Inspiration: moving forward when you do not see the steps.

Te-na- koutou, Te-na- koutou, Te-na- koutou, katoa.

I arrived in New Zealand in 1987 as a new immigrant fresh from the United Kingdom. My first position was not far from here, in Masterton where I was part of a newly established Mental Health Service. As the sole OT for this community team I regularly visited Pahiatua, Ekatahuna, and Greytown and frequently became lost on home visits to clients who lived on rural properties with impossible addresses like RD 23. Nothing in my previous life in England had prepared me for this cultural change. I had left Bristol with a population of about half a million to live in Masterton with at that time 18,000 people. I quickly realised that the differences between my past and my future life were sometimes subtle and sometimes not so subtle. In fact making that move over 20 years ago has been a significant influence to my life both personally and professionally.

Learning to live in New Zealand resulted in developing an awareness of cultural differences between people. I had not expected New Zealand to be different from the UK. The road rules and cars, most of the television programmes, the churches, the food, and the music being played on the radio were all familiar. What was most apparent to me though was that people were different; the values, sense of humour, the way they lived, the things they did and the national Kiwi pride. At first all this was rather strange to me, but over 14 years it has shaped my culture.

Culture is dynamic (Watson, 2006), it is ever changing; individuals and communities change over time as a result of different influences. Although some aspects of our culture will stay with us throughout our lives and be passed on to the next generation, we are not culturally stagnant. Watson, (2006) suggests that 'In the modern world [cultural identity] is increasingly complicated and influenced by globalisation. Most people therefore can no longer be regarded as being wholly embedded in a single group or culture, and the idea of many-sided identities has become popular.' (pg 152)

Similarly, professional cultures evolve and are ascribed to the process of socialisation, during training and education and continue through professional practice (Hall, 2005). The culture of occupational therapy reflects the original values of the profession as our inheritance which, over the course of time, has adapted to changes in technologies and social structures that influence the way we live. It is through these cultural changes that the profession endeavours to meet the changing needs of clients, and of the societies in which we work.

This paper focuses on the possible future of the occupational therapy profession as we strive to adapt and respond to demands of the future world. It is a reflection on the cultural changes observed in the profession and the predicted changes that will come. By using the metaphor of steps to envisage our journeys into the future it is proposed that alternative responses to the diverse cultural and occupational needs of people will evolve.

Occupational therapy in a changing world

According to some scientists the world and consequently the well-being of its inhabitants, may be in serious trouble due to a number of factors; Global warming, rising oil prices, water and food scarcity, the growing and aging population, pandemics such as HIV, obesity and diabetes, labour skills shortage, human rights issues such as slave labour and child trafficking and natural disasters such as those seen recently in Myanmar and China. These global issues will influence our futures in unforeseen ways. It seems that many of these issues will directly affect us as individuals and professionals as they will affect the communities that we serve. The demands of the future are as yet unknown so how can we as individuals and as a profession move forward, when we do not see the steps.

At the latest World Federation of Occupational Therapists Congress held in Sydney, Sohail Inayatullah (2006) said of the occupational therapy profession:

   In the past few years of professionalisation what has been
   pushed away has been the social justice self, the politics
   of a globalising and inequitable world. It appears that
   integrating carer, professional and social justice aspects of
   self are important next steps.

Although not an occupational therapist, Sohail challenged the international occupational therapy community to dare to envision the alternative futures for occupational therapy and for therapists.

The concept of justice is embedded in the professions aspiration of 'occupational justice' through enabling individual and social change (Wilcock, 2006). Justice is one of the foundations of the profession and can be achieved through discovering the occupational potential of those who are disadvantaged (Townsend & Polatajko, 2007). Historically the profession has focussed on those with physical and mental disabilities and has delivered services to promote rehabilitation of clients. More recently the concept of occupational justice has focussed the attention of the profession to include other disempowered, disadvantaged, occupationally deprived and alienated groups in society (Wilcock, 2006). Whereas once the aim of rehabilitation was to mainstream or 'normalise' people, the future focus of the profession will be to identify diversity within society and enable participation by challenging the social norms that constrain and limit meaningful occupation.

We know as occupational therapists that the personal and professional journeys are integrated, inasmuch as what we do influences who we are and what we become. Occupational therapists express both personal and professional values in acting towards a more equitable world, to ensure occupational justice for all people regardless of disability, poverty or race. At an international level, contradicting the promise of globalisation, the inequality in our societies continues to increase.

Inequality and occupational justice

The Gini coefficient is a statistical measure of inequality between rich and poor within the same country. It is expressed as a ratio between 0 and 1; zero represents perfect equality, where every one is equal, and 1 represents perfect inequality, where one person has all the income and everyone else has zero. Although South America and Africa have the highest levels of inequality, in fact New Zealand at .36, Australia at .35 and America at .40 have considerably higher scores of inequality than Japan and the Scandinavian counties, at around .25, and many of the eastern European countries, with around .28 (United Nations Development Program, 2007).

The link between inequality, poverty and occupational injustice, affects not just third world countries but certain populations within strong economies e.g. indigenous peoples, disengaged adolescents, homeless people, people with enduring mental illness, rural and remote populations, and a growing aging population with inadequate savings. The connection between these social determinants in the context of global warming results in increased health and wellbeing risks to a growing global population of disadvantaged peoples.

The United Nations recently stated "Ill health is one of the most powerful forces holding back the human development potential of poor households" (United Nations Development Program, 2007). Coupled with global warming, economic disadvantage across the world will have repercussions in health status. Climate will interact with health in complex ways, producing a range of new threats especially to those who are least equipped to respond. The most vulnerable to climate change are the young and the old (Campbell, Smith, Davies, Kuipers, Wakerman, & McGregor, 2008).

It has been estimated that rising temperatures will increase exposure to malarial infection by 16%-28%. This single preventable disease currently claims 1 million lives a year. Other infections such as cholera, dengue and other vector-borne diseases are predicted to increase, while floods, droughts, storms and heat-waves will result in more frequent deaths and disasters across the world, and not just in developing countries.

Drought is already being experienced in many areas where agriculture has traditionally been the main occupation, affecting the wellbeing of many farming communities. The effects of drought are far reaching in these areas; not only to economic wellbeing but also to health. The threats to physical health and mental health will be compromised by increased stress and social losses, and the severing of links between the individual and their land, recently coined psychoterric illness (Periera, 2008).

From a professional perspective, the current indicators point toward an increasing need for occupational therapists in broadening areas of professional practice (Pattison, 2006). There is growing acknowledgement that in order to meet the needs of increasingly diverse consumers of occupational therapy we will be required to re-invent our selves within the scope of the professions philosophy (Watson, 2006). Occupational therapists need to be flexible and adapt interventions to meet the future needs of our clients, rather than bound by either tradition or 'professionalisation'. In short we are living and working in the dark, we are unable to see clearly what is in front of us and in order to walk forward we can no longer rely on the traditional knowledge and practices of the profession. We need to move forward in new ways and with new goals. This requires what Marilyn Paterson (2006) called "a leap of faith" and 'Inspiration' helps us to negotiate our way ahead.

Inspiration--The inner spirit

On January 12th, 2008 Sir Edmund Hillary, possibly the most famous New Zealander of all time, died at the age of 88. As the first person to stand at the peak on Mount Everest, in 1953, he achieved world fame not only for himself but also for the Sherpa peoples of the Himalayas. At his funeral Helen Clarke acknowledged him as "an inspiration and a role model to generations of New Zealanders". In addition to his mountaineering achievements, Sir Edmund inspired the world by his philanthropy. By establishing the Himalayan Trust, with international partners worldwide, Hillary used his fame to improve the daily lives of the Nepalese Sherpa people. This achievement will continue to benefit the world long after his death. In her tribute Prime Minister Clark defined Sir Edmund Hillary's great attitude using the following words; courage; a determination to succeed; a can do pragmatism; humility, an innate sense of fair play and immense compassion for others. These characteristics are part of New Zealand culture; they are characteristics that are valued by New Zealanders and express the spirit of New Zealand and therefore the spirit of the New Zealand Occupational Therapy profession. As a group, New Zealand occupational therapists can express this inner spirit, as inspiration, to the international community.

[ILLUSTRATION OMITTED]

Professional inspiration

As professionals, our inspiration can be observed in different ways;

1. Inspiration may be the continual drive that sustains our efforts at work, day in and day out and helps us to persevere when the odds are against us.

2. In the 'out of the ordinary' sense, inspiration may encourage us to change our practice, to expand our existing role, to imagine ourselves working in a completely different role, or to reflect on the work that we currently do and realise its potential in a new and exciting way.

3. Lastly, inspiration is the creative force that enables us to find a different approach to the problems we encounter, and helps us to develop creative solutions. To discover through practice new ways of being.

In each of these ways inspiration is the source from which we can draw energy to drive our actions in order to meet the challenges ahead. As individuals, local groups and as a profession, we can express our inner spirit in ways that integrate our caring, professional and occupational justice self, in this globalised and inequitable world.

1. The drive that sustains daily work

In this first way inspiration can be seen as the breath of life. The alternative meaning of this word is breathing in, an essential act if we want to keep living. Inspiration signals the start of life as a natural response to birth, and continues until we die; indeed it is when inspiration stops that we know life has ended. In our professional lives inspiration sustains our efforts at work. As an educator I have observed this inspiration in graduates about to begin their professional careers. We enter the profession with a deeply held conviction that our work makes a difference to the lives of others and society. Like the newly born inspiration sets us off on our journey. As we continue in our career there are times when we lose touch with our inspiration, when we are working in roles that are not satisfying. Studies have shown that job satisfaction for occupational therapist is related to intrinsic factors such as a sense of achievement and an environment that reflect personal values (Randolf, 2005; Moore, Cruikshank, & Haas, 2006).

The connection between our daily work and our inner spirit may be distanced by seemingly endless and frustrating tasks required by the systems in which we work. When our efforts are separated from our inspiration we feel stretched and less energised, as if we are short of breath. Conversely through our daily interaction with clients we can engage our spirit more fully through interventions that are meaningful. When our work results in positive outcomes for clients we are energised and sustained; we breathe easily. When the outcomes are less than optimal we draw on inspiration to continue our efforts, to keep working within the therapeutic partnership with clients to make a difference. In this sense inspiration is an integral part of daily life and is a renewable energy source essential to professional well-being. As professionals the challenge is to find ways maintain the connection between our daily work and our inspiration. In essence this means engages our inner spirit in our work lives.

In a study conducted with allied health professionals who made infrequent visits to provide services to very remote communities in Australia I came across some truly inspiring people. This study was based on narratives or stories of practice and aimed to discover the attributes of remote allied health professionals (Thomas, 2007). One participant in this study told me a long story about following-up a referral for an elder aboriginal man who apparently needed a walking stick. The therapist went to see the man and tried to establish a relationship with him around his role and purpose. The elder refused the walking stick and sent him packing. Six months later the same therapist went with a group of people from the community to see some rock art with the same elder, who was teaching them about the art and its significance. The therapist was genuinely interested in the art and asked him some questions and had a lengthy conversation. At the end of the visit the professional again told the elder that he was working with the health team and that he had a walking stick in the back of the car, if he wanted it. This time the elder accepted the offer and subsequently a few of his friends asked for help from the health team. On reflection the participant said: "these are two different ways to work as a health professional ... knocking on the door for a referral or just as a person in a relationship with somebody else." His final quote was "Its feeling safe enough that nobody was going to say to you, you can't do that, that's not what you're paid to do."

Occupational therapists have the scope to practice in ways that allow meaningful engagement with clients and communities in real relationships. Engaging the inner spirit in our work lives means being able to engage in a person to person relationship in our daily interactions rather than hiding behind a professional role that may be culturally inappropriate. This takes humility and compassion, and a willingness to understand the world view of our clients. Using our inspiration as the breath that sustains our professional lives we can engage the inner spirit in our work and form partnerships in occupational justice for clients.

2. The courage to make changes and expand practice

In this second way inspiration provides a stimulus to change our work practice, redirect our actions and align us with the inner spirit. For some this instigates a change in position, providing the opportunity to work in ways that match our values. For others it may be a change in focus, perhaps to undertake additional responsibilities, like supervising students, managing services or undertaking research. For some the turning point may be in working toward changes at an organisational or political level that will result in better services for clients and communities. What ever the change, we need courage and determination to develop the necessary skills to extend our careers in a new direction.

It is important to recognise the difference between motivation and inspiration. The concepts are similar as both inspiration and motivation compel action. Motivation whether intrinsic or extrinsic, is often emphasised in the workplace and in society in general. The concept suggests our action is directed toward a motive; salary, advancement, security, learning, happiness. Inspiration on the other hand is what allows people to discover a greater potential, to achieve greatness. For this reason inspiration is often attributed to something or someone greater than ourselves. Professional inspiration may be generated from good supervision, reading or observing others the greater expertise or knowledge or simply believing in the value of occupational therapy.

Inspiration is not directed toward a specific goal, it originates from within as a drive, allowing expression of our unique spirit through actions that are inherently meaningful. In simple terms this could be seen as the difference between acting from the head or the heart. When we act from the heart, from a source of inspiration, we discover our own potential; when we are driven to achieve goals without inspiration even when we are highly motivated we may discover our limitations in energy. As has recently been said "in this society our lives suffer from an excess of motivation and a deficiency of inspiration" (Schumaker, 2006, p. 205)

Being inspired to make changes in professional practice, to expand professional roles or to realise new potential requires the courage to take risks. There are occasions when occupational therapists need to move forward in order to progress, without necessarily having permission do so. For instance in situations when you need to make an immediate decision or when you need to demonstrate the value of occupational therapy in a new way. Such risk taking permits us to walk forward with caution to meet the needs of clients and communities in new ways. In my experience it is often easier to get acceptance of a sincere apology if necessary, than to get permission to do something in the first place.

One way that occupational therapy has evolved and expanded in recent years has been in the development of role-emerging fieldwork placements and alternative supervision models. Initially the creation of role emerging placements were regarded with some suspicion by many in the profession, many people believed these placements to be inferior. There was no agreement by the profession to support this development however ten years later things have changed and many programs now see project placements or participatory action placements as an integral part of preparation for practice. In my role as fieldwork coordinator in New Zealand and in Australia I have been inspired to promote the use of project and role emerging placements to expand occupational therapy and its role in different organisations and practice areas (Thomas, Penman, & Williamson, 2005).

Another example is the development of a relationship between James Cook University and a children's rehabilitation centre in Vietnam. The inspiration for this project originated from working with Vietnam Veterans with Post Traumatic Stress Disorder. After working with these clients, I took a holiday in Vietnam to find out more about the country that had left so many Australian veterans psychologically damaged. Through a contact from the university I was taken to visit the National Centre for Orthopaedic Rehabilitation of Disabled Children in Ho Chi Mihn City. The centre provides orthopaedic surgery and physical rehabilitation to children who were disabled. Many children had cerebral palsy or congenital disabilities and would have responded well to occupational therapy if it had been available at an earlier stage. However, in Vietnam there is currently no occupational therapy course or recognition of the profession.

At the end of the visit I had committed to bring occupational therapy students to the centre on an annual basis to try to improve the services offered and teach the staff about occupational therapy practice. Since then, four groups of occupational therapy students and supervisors have completed fieldwork placements at the Centre and this year a second group were placed with a charity in Hoi An. I share this story because it exemplifies how inspiration can drive a process. At that time I did not have the permission of the University to make that commitment and I wasn't sure if the plan would be supported, I simply knew that this needed to happen. I am very grateful for the support I received from James Cook University to continue the placement.

Making changes in the way we work requires courage and determination, especially when you do not know what the outcome will be. The courage to begin the Vietnam project came from the inspiration to improve the situation for the children at the centre. The fact that we have continued annual visits to the Centre for four years, is the result of a great deal of goodwill and the hard work of many people who have helped to make the project work. We cannot change things alone; we need co-inspirational actors, or conspirators, people who are willing to support us to make steps forward, share their energy and help to sustain these actions. Creating new opportunities to work in ways that are personally meaningful has inherent value and offer enormous rewards; working together with colleagues who share our inspiration and perspectives supports us to move forward, to expand the profession to address occupational injustice.

3. Inspiration as creativity

The third way to observe inspiration in our professional life is as the creative force that enables us to develop new ways of being. In this form inspiration is connected to artistry, and the creation of something beautiful, mystical or new. In Greek mythology, all creative inspiration was attributed to the grace of a sisterhood of nine Goddesses or spirits, called the muses. The name continues as the basis of words such music, 'amuse' and to muse upon. Though we no longer pray to Greek Goddesses to provide inspiration, professionally we continue to look to those occupational therapists who promote the development of the profession for our inspiration.

These individual occupational therapy 'muses' play a significant role in our work. They may be great theorists and writers, experts or exemplary practitioners, they may be our peers and work colleagues. Some may be our clients and their families. These are the people who influence occupational therapy practice to move forward to meet the needs of the clients or the communities that we serve. In their own way such individuals influence the professional and encourage creativity and growth. Creative inspiration is the instrument by which we can develop new models of practice that will meet the need of the future. Occupational therapy has traditionally recognised the value of creativity as a means for expressing the authentic sense of self (Blanche, 2007). Discovering new ways of working requires careful reflection on our professional identity, awareness of our fundamental philosophy and a willingness to adapt our services to meet the needs of the future.

One of the greatest expansions of the profession over recent years has been the growing realisation of the need to recognise different cultures within occupational therapy practice. Internationally the profession is recognising the cultural domination of western philosophy in the development of occupational therapy theory allowing new and alternative models to evolve. The dissemination of the Kawa model has challenged dominant cultural perspectives and their appropriateness to people from different cultures (Iwama, 2006). Similarly occupational therapists in Africa have recognised the difference between Afrocentric and Eurocentric worldviews as collectivist and individualistic. Watson (2006) has encouraged occupational therapists to discover the relevance of the profession for each culture, population, and person.

There is an immediate need to develop diverse and culturally appropriate models of practice aimed to improve the situation of people who are disadvantaged and marginalised. Further occupational therapists need to act as agents of social change to tackle political systems that result in occupational alienation. In order to discover new ways of working occupational therapists need to work collaboratively with clients and communities while being aware of our individual and professional cultures and recognising the alternative worldviews of the people that we work with.

The concept of diversity within the occupational therapy profession recognises that there are different and conflicting views of the world which are all equally valid. Diversity is bounded by our professional discourses, our shared knowledge and identity and is informed by reflexive and ethical responses to the demands of the future (Mackay, 2007; Weimblatt & AvrechBar, 2001). Accepting a need for diversity affirms that there are many ways of being an occupational therapist. Diversity is not a new concept. In the past diversity has divided the occupational therapy profession into practice ghettos. The concept of being a 'mental health' occupational therapist or a 'physical' occupational therapist has separated the profession and created identity confusion. We need to move forward from the concept of diversity to a commitment to pluralism across the expanding range of contexts that constitute occupational therapy practice. A commitment to pluralism will provide greater opportunities for cultural exchange and nurture the necessary creativity to sustain the profession in an ever changing world.

A commitment to pluralism requires actively seeking understanding of what is important to other people. Pluralism is more than just tolerance (Eck, 2008) it requires that we aim to remove ignorance and leads to discovering more about each other. Becoming pluralistic results in a profession that is committed to expressing the range of differences that reflect the people and the communities in which we work. This commitment then challenges the right of one group of occupational therapists to dominate other groups even if they are numerically greater or have privileged status.

In effect the profession needs to be de-colonised and the knowledge and experience of New Zealand occupational therapists can help to achieve this. A Maori proverb "walk backwards into the future" highlights the importance of seeking to understand the present through reference to the past. As we move forward to address occupational justice we can draw creative inspiration from the past, and re-invent the future to meet the demands of marginalised and alienated groups. As a profession we can learn from our different journeys as we develop the future cultural identity of occupational therapy.

There have been significant developments within the New Zealand occupational therapy profession in the eight years since I left. During this period New Zealand occupational therapists have demonstrated a growing commitment to developing bicultural occupational therapy practice. New Zealand authors have advocated strongly for culturally safe practice (Gray & McPherson, 2005; Jungersen, 2002). More recently the principles of Kaupapa Maori have further recognised the value of Maori ways of knowing, doing and understanding to protect the rights of Maori to cultural autonomy and self-determination. By working towards incorporating these principles in practical ways as part of occupational therapy practice, New Zealand occupational therapists have a great deal to teach the world and to be an inspiration to occupational therapists in other countries.

It is timely for New Zealand occupational therapists to offer their creative inspiration and contribute Kaupapa Maori perspectives of occupational therapy to the international discourse. The expression of the spirit of New Zealand occupational therapist in developing new ways of working that are culturally safe and just is inspirational and can help us to move forward in a globalised world.

Conclusion

In New Zealand, where humility is greatly valued there is a reluctance to be different and yet New Zealand occupational therapists are different culturally and this is a difference that we can be proud of. Any expectation that we are all the same, indeed that we should be the same, limits our actions as a profession. If we are going to move forward to meet the demands of the future we will need to ensure there is scope to develop in different ways, whilst maintaining a commitment to the profession and in return gain validation from a forward thinking and proactive profession that is committed to its own future.

Through reflecting on the theme of Inspiration, I have proposed that as individuals and as a profession we need to move forward to address social injustice in a world of increasing inequality between rich and poor and across cultures. To do so will require a sustained inner drive, the courage to make changes and expand practice and creativity of new discoveries. Finally I have suggested that we need to go beyond diversity to embrace pluralism of cultures within the profession. In this way New Zealand occupational therapists have the wisdom, experience and the right attitude to make a significant contribution to the future development of the International profession as it strives to improve the health outcomes of communities and countries. I proposed that the essence of New Zealand's spirit is not dissimilar to that of Sir Edmund Hillary's

* courage

* a determination to succeed

* a can do pragmatism

* humility

* an innate sense of fair play

* immense compassion for others

The future of occupational therapy as a profession in this globilised, socially unjust and inequitable world is to find a way to combine our personal and professional roles. To act authentically and intentionally, in ever increasingly new ways towards ending discrimination and ensuring occupational justice for all.

References

Bedford, R. (2006). Skilled migration in and out of New Zealand: Immigrants, workers, students and emigrants. In B. Birrell, L. Hawthorne, & S. Richardson, Evaluation of General Skilled Migration Categories. Canberra: Commonwealth of Australia.

Blanche, E. (2007). The expression of creativity through occupation. Journal of Occupational Science, 14(1), 21-29.

Campbell, D., Stafford Smith, M., Davies, J., Kuipers, P., Wakerman, J. & McGregor, M. (2008). Responding to health impacts of climate change in the Australian dessert. Rural and Remote Health, 8: 1008. Retrieved August 28, 2008 from http://www.rrh.org.au

Cresswell, J. (2003). Research design: Qualitative, quantitative and mixed methods approaches. Thousand Oaks: Sage Publications.

Eck, D. L. (2006). What is pluralism? The Pluralism Project, Harvard University--Retrieved March 18, 2008 from http://www.pluralism.org/ pluralism/what_is_pluralism.php

Gray, M., & McPherson, J. (2005). Cultural safety and professional practice in occupational therapy: A New Zealand perspective. Australian Occupational Therapy Journal, 52(1), 34-42.

Hall, P. (2005). Interprofessional networks: Professional cultures as barriers. Journal of Interprofessional Care, 19(2), 188-196.

Inayatullah, S. (2006, July). Alternative futures for occupational therapy and occupational therapists. Keynote presentation at World Federation of Occupational Therapists Congress, Sydney, Australia.

Iwama, M. (2007). Embracing diversity: Explaining the cultural dimensions of our occupational therapeutic selves. New Zealand Journal of Occupational Therapy, 54(2), 16-23.

Jungersen, K. (2002). Cultural safety: Kawa Whakaruruhau--An occupational therapy perspective. New Zealand Journal of Occupational Therapy, 49(1), 4-9.

Mackay, H. (2007). 'Do not ask me to remain the same': Foucault and the professional identities of occupational therapists. Australian Occupational Therapy Journal, 54(2), 95-102.

Moore, K., Cruickshank, M., & Haas, M. (2006). Job satisfaction in occupational therapy: A qualitative investigation in urban Australia. Australian Occupational Therapy Journal, 53(1), 18-26.

Pattison, M. (2006). O T - outstanding talent: An entrepreneurial approach to practice. Australian Occupational Therapy Journal, 53(3), 166-172.

Penman, M. (2007). Transforming views of learning: connecting professional conversation. New Zealand Journal of Occupational Therapy, 54(2), 415.

Pereira, R. H. (2008). Population health needs beyond ratifying the Kyoto protocol: A look at occupational deprivation. Rural and Remote Health, 8: 927. Retrieved August 30, 2008 from http://www.rrh.org.au

Randolf, D. (2005). Predicting the effects of extrinsic and intrinsic job satisfaction on recruitment and retention of rehabilitation professionals. Journal of Healthcare Management, 50(1), 49-60.

Schumaker, J. (2006). In search of happiness: Understanding an endangered state of mind. Auckland: Penguin.

Smith, G. (1990). Principles of Kaupapa Maori. Retrieved August 20, 2008 from http://www.rangahau.co.nz/research-idea/27/

The Himalayan Trust Vision. (2008). Retrieved March 18, 2008 from http://www.himalayantrust.co.uk/index.phtml

Thomas, Y. & Clark, M. (2007). The aptitudes of allied health professional working in remote communities. International Journal of Therapy and Rehabilitation, 14(5), 216-220.

Thomas, Y., Penman, M., & Williamson, P. (2005). Australian and New Zealand fieldwork: Charting the territory for future practice. Australian Occupational Therapy Journal, 54(1), 78-81.

Townsend, E., & Polatajko, H. (2007). Enabling occupation 11: Advancing an occupational therapy vision for health, well-being and justice through occupation. CAOT: Ottawa.

United Nations Development Program, (2007). Human Development Report 2007/2008. Retrieved May 5, 2008 from http://hdr.undp.org/en/ media/HDR_20072008_EN_Complete.pdf

Watson, R. (2006). Being before doing: The cultural identity (essence) of occupational therapy. Australian Occupational Therapy Journal, 53(3), 151-158.

Weimblatt, N., & Avrech-Bar, M. (2001). Post modernism and its application to the fields of occupational therapy. Canadian Journal of Occupational Therapy, 68(3), 164-170.

Wilcock, A. (2006). An occupational perspective of health. Slack: Thorofare

Yvonne Thomas, Dip COT, MEd

Senior Lecturer--Occupational Therapy

School of Public Health, Tropical Medicine & Rehabilitation Sciences

James Cook University, Townsville

QLD 4811

Australia

Email: [e-mail]