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Doing well-doing right together: a practical wisdom approach to making occupational therapy matter.

When invited via SurveyMonkey to share how we had experienced the conference, without intending to romanticize the event, what stood out for me was the gathering's embeddedness in the context of Maori culture and tradition. It opened with the Powhiri--the ritual ceremony of welcome/ encounter involving speeches, dancing, singing and hongi, a traditional Maori greeting, which is done by pressing one's nose and forehead at the same time to another person at an encounter, during which the 'ha' (or breath of life) is exchanged or intermingled (Himona, 2006); the conference featured the first ever Maori Frances Rutherford Lecturer--Jane Hopkirk; its AGM members voted that the association would also have a Maori name--Whakaora Ngangahau Aotearoa, which translates as 'Occupational Therapy New Zealand'; it bestowed special honors, manaaki (support) and taonga (treasure), pounamu (greenstone) toki pendants for all the keynote speakers; and it closed with the Poroporoaki--the farewells/goodbyes which incorporated reflections of the event, the good and the bad (Maori Dictionary, 2013). The sense I got from the honouring moments and the presence of the Maori elders who led these cultural rituals/ceremonies throughout, is that they allowed the gathering to transcend beyond being a mere professional conference centered on furthering professionals' interests. It became a space for Maori, Pakeha (New Zealanders of European descent) and international delegates to connect with what might be considered occupational therapists' ultimate purpose, i.e. understanding and practicing 'doing well--doing right together'.

Introduction

In line with Maori tradition, and appreciative of the anthropologist Lila Abu-Lughod's (1991) stance "that every view is a view from somewhere and every act of speaking, a speaking from somewhere" (p. 141), the 'Maramatanga Hou--Fresh Perspectives' that I am sharing in this paper are informed significantly by a diversity of 'somewheres', as the following account of my personal history will illustrate. These will be presented in three 'stages', each highlighting discoveries or lessons learnt, not those taught at school or gleaned through books but through living in and engaging with the world.

Personal history in three 'stages'

1964-1985: I was born in 1964 in the Netherlands' catholic south as the oldest of four siblings of World War II survivors Theo and Nelly Kronenberg. Both hailed from baker families and had continued the tradition of putting food on our family's table by providing others with 'daily bread'. Our customers included people who lived and worked in my hometown's large mental health institutions which back then were largely run by catholic orders, such as the Sisters of Saint Joseph, the Ursuline Sisters and the Franciscans (OFM). Every now and then missionaries visited my primary school to present their 'development projects', through which I gained my first significant exposure to peoples in other parts of the world who appeared, spoke, ate, lived differently from us and who seemingly where in need of some help with 'getting their lives on track'. After graduating at age 19 from teacher's training college, I considered myself to be too young and inexperienced to be entrusted with the responsibility to prepare 'little human beings' for life and living in the big world. I felt that I needed to find out about this 'bigger world' up close and personal, travel and work abroad a bit, immerse myself in what I would today call an 'experiential diagnosis of how our world is doing'. For example, I felt a kind of push to explore the origins and meanings of what was commonly referred to as 'first, second, third and even fourth world', whilst it appeared to me that as people we seem to be inextricably bound together by the habitat we occupy. Mainly instilled by my parents' upbringing, one of the lasting discoveries during my first 20 years of life is that humans cannot do without each other.

1986-1995: Although I didn't mean for this journey to last almost a decade, that is how it unfolded. I lived, worked, and travelled in different regions of the world, engaging in so called 'developed' and 'developing' contexts. In very broad strokes, these experiences included a kibbutz in Israel; healthcare, education and community development initiatives in Nepal, Pakistan and India; attending to the needs of children and adults with physical disabilities and youth-at risk in New Jersey and New York; and engagements with so called 'street children' in Mexico City.

The overall sense I got from 'how we are doing as a world' was that 'whilst seemingly waging war against itself and the planet, humanity is struggling on to keep alive what makes us human'. I then wanted to better understand this 'human condition' and learn what it may take to bring out 'the best' and 'prevent the worst' that humans are capable of. This need basically 'pulled' me back to the university.

1995-2012: The aforementioned intense and rich years prompted me to seek further formal training and to 'put into some kind of order' all that I had experienced. That is when I found my 'conceptual home'-'human occupation for health', which appreciates the complex relationship between doing and wellbeing. I graduated with a bachelor's degree in occupational therapy in the Netherlands but was unhappy with what might be considered as the (then) depoliticized condition of our profession's original activist-social vision (Frank & Zemke, 2008), which attracted me to it in the first place. With Salvador Simo Algado, a like-minded colleague from Spain, I founded what is today called a movement: 'occupational therapists without borders'. It produced a number of international ground breaking publications (Kronenberg, Pollard, & Sakellariou, 2011; Kronenberg, Simo Algado, & Pollard, 2007; Pollard, Sakellariou, & Kronenberg, 2008), through which, perhaps not surprisingly, I also met my wife and mother of our two daughters. Together we are committed to making South Africa home. Besides being involved with Shades of Black Works, Grandmothers Against Poverty and Aids, and Isango Ensemble (see websites), I have embarked on a PhD in occupational therapy/occupational science at the University of Cape Town.

I now wish to return to the aforementioned notion of 'home', given that it required to be given new meaning. A large portion of the Netherlands is located below sea level, and the fight with water and reclaiming land from the sea (first documented in 1533) has dominated its history (Kazmierczak & Carter, 2010). The Netherlands is often popularly referred to as Holland, 'the land of tulips, wooden shoes, cheese and windmills'. But, it is also the birthplace of Jan van Riebeeck, who was appointed by the Dutch East India Company (VOC) to establish a refreshment station at the Cape. His landing in April 1652 marked the irreversible beginning of the end of indigenous cultures, of their ways of organizing society and of knowing. It has even been claimed that Van Riebeeck may have opened up the floodgates for the total colonization of independent political entities and free people (South African History Online [SAHO], 2013a). Another native of the Netherlands was Henrik Verwoerd, who later became the Prime Minister of South Africa, but who in world history will most likely be remembered for being the creator of apartheid (SAHO, 2013b).

Frankly speaking, I never imagined that one day, I would have my own family and commit to making home, the same land that the Dutch natives Van Riebeeck and Verwoerd (among others) had left with intended and unintended consequences of almost four centuries of colonization and 46 years of apartheid law (1948-1994). However, helped by the words of the South African based Trinidadian author Ronald Suresh Roberts, today home has to do with "where you feel that what you do matters, and I think that to be part of what South Africa [must do] matters for everyone in the world" (Matabane, 2005). In other words, I believe that if all who live in South Africa were to commit to learning to live 'Doing Well--Doing Right Together', then everyone in the world can.

During the keynote I attempted to invite the audience to this particular interpretation of 'home' by showing them a family picture, featuring makhulu, our live-in aunt-grandmother, our daughters Masana Nelly and Isha Tshiala, my spouse Elelwani and myself. The delegates may as well have been looking at their own and each others' families, also identifying three generations. However, the 'somewhere' where this family picture was taken tells a particularly different story than if let's say it would have been taken in the Netherlands, my place of origin. Less than 20 years ago, the apartheid law Prohibition of Mixed Marriages Act No 55 of 1949, prohibited marriages between Whites and members of other racial groups (SAHO, 2013c). Therefore, back then that picture was impossible. And although today it is possible, that does not automatically mean that all those who live in South Africa are equally comfortable with this reality. For example, early on in our marriage (2006-2007), we had experienced direct contrary responses to our 'mixed race family'. In public spaces, the Sea Point Promenade and the Century City mall, local South Africans 'who looked like Elelwani' approached us expressing approval of what they saw, commenting that 'it gave them hope' and that 'things can change'. At another moment, local South Africans who 'looked like me' confessed after a few bottles of red, that they struggled to come to terms with what they saw, not because they were not happy for us, but because of the strong emotions (guilt, shame, rage) triggered by childhood memories of daily reminders by parents, church, school, etc. that a mixing of the races would not be good. Elelwani and I met and married out of love and discovering a 'goodness of fit' of shared personal, professional and political values. It was a deliberate choice to raise our family and to commit to making occupational therapy matter in post-apartheid Cape Town, South Africa. This requires us to remain conscious of and to learn how to best respond to the still divided, wounded, violent, dehumanized and dehumanizing condition of post-apartheid South Africa (Adu-Pipim Boaduo, 2010; Ramphele, 2012; Tutu, 2011), being sensitive to the reality that our mere presence may evoke different reactions from possibly differently wounded people.

Occupational diagnosis: 'How are we doing: World & occupational therapy?'

I acknowledge that the following reference may only work in English, the international lingua franca. If we stop and think about it, does the mundane question that is asked every day all over the world--'how are we doing?-not embody the premise of an occupational perspective of health in the broadest sense of the word? After all, it does not straightforwardly enquire about what people are doing, but it is based on the seemingly taken for granted interrelationship between what we do and our wellbeing. If we were to then project this question on our world or humanity as a whole and then hold it against the light of how occupational therapy is doing in response to an occupational diagnosis of our world/humanity, what might we then find?

The 'diagnostic instrument' we employed to answer the first question 'How is our world doing?' was a video-clip of a unique 'glocal' interpretation of the classic Bob Marley songs 'War/No More Trouble'. It was conceived, put together and posted as 'Song Around the World' on YouTube in 2009 by the NGO Playing for Change (see Websites). To date it hosted more than 10 million visitors and received over 8,000 comments! A review of a couple of hundred of the comments posted by people from different walks of life from all over the world yielded the following 'occupational diagnosis'. our contemporary world seems to be 'hungry', 'thirsty' for opportunities that allow: A) experiencing a deeper sense of belonging; and B) contributing meaningfully to the well-being of others. Interestingly, these findings resonate with the first two discoveries that I highlighted in my personal history. Might this be an indicator that the individualistic tendencies that characterize our contemporary world seem to be spiraling out of control? One could almost regard these as embodying another strand of 'apartheid', dividing and pitching each and every human being against each other and making them compete for supposedly limited resources, pushing everybody to be better and stay ahead of the next person, be they individuals, families, organizations, communities, countries, and/or regions. Among other social ills, 'individualism in overdrive' seems to be failing us, it is failing humanity and its habitat!

Let us now occupationally diagnose 'How is occupational therapy doing in response to how our world is doing?' For this we employ Cohen's anecdote, which Sandra Galheigo used to start off her closing keynote at the 2010 WFOT world congress in Santiago de Chile (Galheigo, 2011):
 A man is walking by the riverside when he notices a body
 floating down stream. A fisherman leaps into the river, pulls
 the body ashore, gives mouth to mouth resuscitation, saving
 the man's life. A few minutes later, the same thing happens,
 then again and again. Eventually yet another body floats
 by. This time the fisherman completely ignores the drowning
 man and starts running upstream along the bank. The
 observer asks the fisherman: 'What on earth are you doing?
 Why are you not trying to rescue this drowning body?' 'This
 time', replies the fisherman, 'I'm going upstream to find out
 who the hell is pushing these poor folks into the water'.


After citing this anecdote, Sandra meaningfully paused, and she then pointed out to a worldwide audience: 'Some of us find themselves attempting to rescue drowning bodies from the river. More of us should also be doing that. But this is no longer enough. Occupational therapists have an ethical-political responsibility to also commit to understanding 'upstream' structural conditions that produce and perpetuate social ills that manifest downstream' i.e. social determinants of health (World Health Organization [WHO], 2008). I would like to extend this analogy by proposing that it seems to be called for, to go even beyond 'upstream', to the origins of the river, to the source of what in-deed [pun intended] makes us human, to learn where, when, how we might be losing (sight of) this as life flows (away) from the source.

Evidenced by a steady production of position papers (Diversity and Culture, 2010; Environmental Sustainability: Sustainable Practice within Occupational Therapy, 2012; Human Displacement, 2012; Human Rights, 2006) and a commitment to translate these mandates in the minimum standards that are currently undergoing revision (anticipated year of publication 2014), the World Federation of Occupational Therapists (WFOT) seems to underscore Galheigo's (2011) reminder of our ethical-political responsibilities. Take for example the following excerpt from the WFOT position paper on Human Rights, which identifies "six global conditions that create barriers to human occupation: poverty; disease; social discrimination; armed conflict; natural disasters; forced displacement" (WFOT, 2006, p. 1). Informed by the bakery milieu in which I was raised, I understand this mandate as valuing 'human occupation for health' simply as 'the other daily bread', which is as fundamental to people's health and wellbeing as eating, drinking, belonging and loving (Kronenberg, 2012a).

The argument presented here is, that central to the issue of access to health-promoting occupations is the capability for individuals and collectives to influence their own unfolding occupational narratives (Ramugondo, 2012). Therefore, the process of making occupational therapy really matter, that is for our profession to become socially, culturally, economically, politically relevant and accessible to people from all walks of life, seems to require occupational consciousness: an ongoing awareness of the dynamics of hegemony, an appreciation of the role of personal and collective occupations of daily life in perpetuating hegemonic practices, and an appraisal of resultant consequences for individual and collective well-being (Ramugondo, 2012). Occupational consciousness calls for tapping into sources of knowing that move beyond the purely theoretical analytical and technical. A practical wisdom approach to making occupational therapy matter is proposed. This approach involves an in-depth, reflexive analysis of how particular sets of values and power interplay in what we are doing/not doing with and to ourselves and others in our everyday lives and how this influences our health and our responsiveness, or lack thereof, as occupational therapists.

A practical wisdom approach to making occupational therapy matter

This paper does not allow for a thorough exploration of practical wisdom, but I intend to offer what may serve as an introduction, to trigger or feed your imagination of such an approach to making occupational therapy matter.

What is practical wisdom? According to Aristotle (1976), practical wisdom is the most important of the three intellectual virtues that he identified: episteme--scientific knowledge; techne--applied knowledge or know-how; and phronesis--practical knowledge or wisdom. Wisdom refers to knowledge about things that matter (Glossop, 2003). John Bradshaw (2009) described practical wisdom as the ability to do the right thing, at the right time, for the right reason, which resonates with Aristotle's shorthand definition 'the combination of moral will and moral skill'.

In his TED talk (see websites) "The loss of wisdom" Barry Schwartz (2009) shared:
 A wise person is made, not born. Wisdom depends on
 experience, and not just any experience. You need the time
 to get to know the people that you are serving. Practical
 [or applied or situational] wisdom feeds the moral will
 to do right by other people, and beyond this, the moral skill
 to figure out what doing right means. This translates practically
 into knowing: when and how to make the exception to every
 rule; when and how to improvise. Real world problems are
 often ambiguous and ill-defined, and the context is always
 changing. Practical wisdom is exercised as jazz musicians
 play music, using the notes on the page, but dancing around
 them, inventing combinations that are appropriate for the
 situation and the people at hand. It is also about knowing
 how to use the moral skills in pursuit of the right aims.


This kind of knowing what ought to be done, speaks to Galheigo's call for occupational therapists to be more (pre)occupied by our ethical-political responsibility, that is, exercising a 'concern with what is good or bad for Man and Planet' (Aristotle, 1976).

Aristotle believed that everything had a telos, that is its aim, purpose, or maximum potential (Aristotle, 1976). What if we were to identify as the telos of occupational therapy, contributing to advancing understandings and practices of 'doing well-doing right together', attempting to overcome 'so what' perceptions of occupational therapy's traditional roles juxtaposed against how our world and humanity is doing as a whole?

Drawing from the self-identified phronetic social scientist Bent Flyvbjerg (2001), a practical or situated wisdom approach to making what we do as occupational therapists matter would aim to balance instrumental rationality [theoretical and applied scientific knowledge] with value-rationality by increasing the capacity of individuals, organizations and society to think and act in value-rational terms (Flyvbjerg, 2001). By focusing on values, Flyvbjerg pointed out, occupational therapists must face the question of foundationalism versus relativism, that is, the position that central values exist that can be rationally and universally grounded versus the view that one set of values is just as good as another. Instead, Flyvbjerg (2001) suggested:
 we are to reject both and replace them
 by contextualism--situational ethics: a practical wisdom approach
 holds that the socially and historically conditioned context--and
 not the rational and universal grounding--constitutes the most
 effective bulwark against relativism and nihilism. We must realize
 that our sociality and history is really the only foundation that
 we have, the only solid ground under our feet. (p. 130)


The following classical Aristotelian value-rational questions (the ethical dimension) and the added inquiry about power and outcomes (the political dimension) may help us with exercising a practical knowledge approach (exercising our ethical-political responsibility) to making occupational therapy matter, engaging in a critical reflexive analysis of values and power (Flyvbjerg, 2001):

* Where are we going?

* Who gains and who loses and by what mechanisms of power?

* Is it desirable?

* What should be done?

The first question resonates with our proposed core concern 'how are we doing?'. The second question interrogates the inclusiveness (or lack thereof) of the 'we' and how this may be structurally maintained. Held against a telos of 'doing well-doing right together', the third and fourth questions push us to find out and negotiate in the particular situated contexts in which we find ourselves and what might be the right thing(s) to do in order to bring about and sustain 'doing well together'.

Inspired by Flyvbjerg's (2001) contemporary reading of Aristotle's phronetic or practical wisdom approach relating explicitly to a primary context of values and power, the following table juxtaposes dominant traditional versus emergent Maramatanga Hou--fresh perspectives of occupational therapy.

There also seems to be a goodness of fit between a practical knowledge approach and the proposal that 'Occupational therapy is essentially a possibilities-based practice, which generates practice-based evidence and complements evidence-based practice' (Kronenberg, Pollard, & Ramugondo, 2011, p 11). Occupational therapists ought not to allow themselves to be too preoccupied with 'what is not' but instead get occupied with 'what is not yet', seeing and helping others and society to see possibilities beyond limitations, and contribute to (social) change from there. This 'seeing' cannot be taught, it is a frame of mind and a value that is to be derived largely from personal experience in and with the world.

Next we will get a glimpse of three implementations of a practical wisdom approach to making occupational therapy matter, i.e. advancing 'doing well-doing right together'. All three can be appreciated as concrete examples of collective occupations-based practices, that is: "Occupations that are engaged in by individuals, groups, communities and/ or societies in everyday contexts; these may reflect an intention towards social cohesion or dysfunction, and/or the advancement or aversion to a common good" (Ramugondo & Kronenberg, 2013, p. 17). Each example will offer some insights in why and how the initiatives came about, which allows for how inferences of value and power rationalities informed and guided decision-making on what needed to be done.

Examples of collective occupations-based practices from Europe and Africa Project Miquel Marti i Pol, University of Vic, Catalonia--Spain

Concerned about the social and ecological challenges of contemporary Europe, Salvador Simo, professor at the occupational therapy department of the University of Vic, in Catalonia, Spain, (simply) brought a group of his occupational therapy students out to a fence on the sidewalk that overlooked an abandoned space of the campus. He then asked them to describe what they saw. A bit puzzled by this unusual situation, they looked at the vacant plot and summed up a number of negatives: 'weed', 'dead trees', 'trash', 'used needles', 'a dead cat', 'a useless plot'. When one of his students returned the same question to him, Salvador replied:

I see the unfolding story of transforming the sad space that you described into a place of beauty, a communal garden ... involving not only you and me but also inviting the people who are on our city's sidewalks but who we seem to habitually overlook or ignore, survivors of mental health, poverty, immigration, (forced) displacement. (personal communication, 27 May 2008)

This is how the Project Miquel Marti i Pol originated. It integrates health, education, research, and poverty alleviation (Simo, 2011). It can also be regarded as a collective occupation (Ramugondo & Kronenberg, 2013) that brings together and meaningfully engages differently situated persons (people living with mental health issues, people who are displaced, students) and multiple stakeholders (university, city council, business sector, civic society organizations, European Community). The project makes effective use of a variety of (social) media to communicate its achievements and challenges to the larger society, part of their commitment to make visible and educate society about the value and potential of excluded people: they are citizens who are contributing to society (Simo, 2011). The project also recreates the university as a school for democracy and citizenship, generating knowledge that matters, i.e. how meaningful engagement in collective occupations can foster spiritual, social, mental and physical wellbeing, and contribute to cultivating inclusive communities and citizenship, and alleviation of poverty. The art of politics and partnerships is central to the process, linking the social-health sectors with the economic and educational sectors. The goal is to create a society based on the values of justice, equality, freedom, active respect and solidarity (Simo, 2011).

To illustrate how various participants' experiences in the project cultivated their practical wisdom, here are some testimonies: A civic sector partner: "The university should help the society to avoid dying (from indifference). If the term university only implies knowledge, it wouldn't serve anything" (Simo, 2011, p. 362). One of the gardeners: "I am known by more people in Vic in two years than in 15years in Centellas [a municipality in Catalonia] ... the garden helped me to enter the community" (Simo, 2011, p. 362). A City Council representative: "To maintain well-being, it's important to take account of the public and the Third Sector's powers, as these strategic alliances are indispensable" (Simo, 2011, p. 363). And from a student who was enabled to look beyond the diagnoses and to discover the person and his or her potential: "Each of them has shown excellent potential for humanity, generosity, sympathy, commitment, friendship" (Simo, 2011, p. 362). And the garden has been a place to encounter the 'Other': "It made me see the world from the other perspective; from the point of view of those socially considered as the "others" (Simo, 2011, p. 362).

Grandmothers Against Poverty and Aids (GAPA)

According to the 2012 UNAIDS World AIDS Day Report, an estimated 5.6 million people were living with HIV and AIDS in South Africa in 2011, the highest number of people in any country (UNAIDS, 2012). In the same year, 270,190 South Africans died of AIDS-related causes. Although this number reflects the huge amount of lives that the country has lost to AIDS over the past three decades, it is 100,000 fewer deaths than in 2001, demonstrating the many lives that have been saved through a massive scale-up of treatment in the last few years (UNAIDS, 2012). The reality that oftentimes remains hidden behind such statistics is that many thousands of gogos (isiXhosa for 'grandmothers') who have lost their children to AIDS are now sole providers for their grandchildren. Although traditionally, grandmothers in Africa have cared for grandchildren, it has not been without financial and emotional support of their children. Overwhelmed by their plight, in 2001 a few gogos and an occupational therapist, Kathleen Brodrick, came together to form a remarkable organization called Grandmothers Against Poverty and Aids (GAPA).

In her own words, Kathleen Brodrick succinctly captures the core philosophy of occupational therapy which also serves as the ethos underlying GAPA's programs:

Everybody is capable of healing themselves, and by healing I mean getting on top of their problems, so it's through activities, such as: doing something concrete, or learning something, or supporting someone or being supported, through these kind of activities you can be healed and you can have a good quality of life. (GAPA promotional video, 2005)

How did GAPA come about? Kathleen explained:

In 2001 I was contracted by the Institute of Aging in Africa, which is a department at the University of Cape Town, to run some workshops for grandmothers who were heads of households where Aids was feature. And halfway through the workshops, the grandmothers started to wonder what would happen once the workshops had finished. And it was very much a case of me saying to them "what do you want to happen to you?" And they said it's been so successful, that they actually would like to teach other grandmothers. So I said "Fine, how are we going to do that?" Ten grandmothers and Kathleen worked out how to become a Non Profit Organization and that was it. (GAPA promotional video, 2005)

The GAPA programs include: Educational Workshops--focusing on practical topics such as nursing skills and HIV/AIDS, tuberculosis, parenting skills, vegetable gardening, human rights and abuse, bereavement, business skills, drawing up wills and how to access government; Support groups--emotionally vulnerable grandmothers are recruited by grandmothers who are known as area representatives to join the support groups that they run in their homes once a week; Income Generation--handicraft items that are wanted by their communities are made and sold within the township and to visitors; Pre-school bursaries--allowing the grandmothers to send their young grandchildren to a safe and stimulating environment whilst having some time to themselves; Aftercare--an enrichment program for vulnerable children who attend the local primary school. Here home work is supervised, the children are fed and a choir has been formed. The grandmothers also teach English literacy, tell traditional stories and teach traditional songs.

In July 2009, GAPA hosted a group of local and international delegates as part of the 'Occupational Justice' Symposium and Think Tank at the University of Cape Town, an experience to which we will return at the end of this paper. After having been introduced to GAPA's gogos and its programs, all of us collectively engaged in vivacious song and dance, during a brief pause, Vivienne Budaza, GAPA's executive director, proudly affirmed: "This is life at GAPA ... no time for self-pity ... no time at all for depression" (personal video-recording 10 July 2009), after which she involved all of us in more song and dance.

When listening to the gogos' life stories, one is struck by the multiple-level challenges they had and have to overcome. The South African photojournalist Eric Miller captured this in the GAPA honouring exhibition 'Amatsha Ntliziyo', colloquially translated 'The Nevergiveups', highlighting the pro-active resilience that the grandmothers display in dealing with the circumstances in which they find themselves (see websites). As with Vivienne's affirmation, what again shines through is how GAPA effectively taps into the healing powers of collective occupation, wherever and whenever the heavy burdens of everyday life have simply become too much to be carried by anybody alone.

Isango Ensemble, Cape Town--South Africa

As shared earlier in this paper, although post-apartheid South Africa is approaching its 20th anniversary (2014), it remains a deeply divided, wounded, violent and to some extent dehumanized and dehumanizing society (Adu-Pipim Boaduo, 2010; Ramphele, 2012; Tutu, 2011). It has crafted what is widely regarded as one of the world's most progressive constitutions (Government Republic of South Africa, 1996), but the realization of its principles into everyday life conditions that allow South Africa to truly be called home by all people who live in it, continues to present as a tremendously complex challenge. Taking this on requires everybody's concern and commitment and contributions ... from where each is best positioned and enabled to contribute.

The Cape Town based South African (opera and) theatre company Isango Ensemble is committed to creating theatre that is accessible to all South Africans and to contributing to a more united South African society. Although its stage productions and films have played to sold-out audiences across the world, and received widespread critical acclaim and international awards, it continues to struggle to build a home, an audience and support in South Africa. In November 2011, Isango Ensemble performed 'Magic Flute' in honour of Arch Emeritus Desmond Tutu's 80th anniversary, after which he expressed his appreciation in an email: "Thank you too for proving apartheid so abominably wrong. You have helped restore our faith in ourselves. Fantastic." (personal communication, 3 October 2011)

Isango Ensemble draws its artists mainly from the townships surrounding Cape Town. Isango's productions re-imagine classics from the Western theatre canon, finding a new context for the stories within a South African or township setting thereby creating inventive work relevant to the heritage of the nation. The company's structure embraces artists at all stages of their creative development, allowing senior artists to lead and contribute towards the growth of rising talents.

Isango Ensemble's Actor Patron Sir Ian McKellen identified a distinguishing feature of how this company impacts its audiences: 'Isango Ensemble is different ... linking high art to the humble lives of its astonishing performers.' (see websites)

Viewing Isango Ensemble's opera and theatre work through the transdisciplinary conceptual lenses of 'occupational consciousness' (Ramugondo, 2012) and 'collective occupations' (Ramugondo & Kronenberg, 2013) allows one to discover their potential as a vehicle or avenue for restoring, (re)building, (re) humanizing a society that suffers from historically damaged human relations. I have been privileged to work with them in the capacity of development director, assisting with building and maintaining a home, an audience and (other) support networks. All that we learn from this 'collective (occupation) arts-based practice' can then be shared with and beyond occupational therapy and occupational science audiences at universities and conferences worldwide.

'Doing well--Doing right together': Contemporizing Mary Reilly's 50 year old adage

We are now close to coming full circle on the 'Maramatanga Hou--Fresh Perspectives' of occupational therapy journey of this paper. Before presenting some closing thoughts, I will share the experience that resonated with the enacted values that made the 2012 NZAOT conference stand out for me, that is, how it honoured Maori cultural traditions and language and the sustained presence and participation of Maori elders.

As mentioned earlier, in July 2009 in Cape Town, South Africa, a symposium and think tank took place at the University of Cape Town (UCT) which explored 'The relevance of an occupational justice perspective in Africa and beyond' (Kronenberg & Ramugondo, 2011, pp. 202/203). It was co-hosted by UCT's Occupational Science Research Group and the International Society for Occupational Science (ISOS). Its participants, besides local, continental and international occupational therapy and occupational science educators, researchers and students also included young adolescents from 'Facing Up' (Joubert, Galvaan, Lorenzo & Ramugondo, 2006) and a few 'gogos' from Grandmothers Against Poverty and Aids. Not only did they actively engage in the discussions and host us to their programs, respectively in the township communities of Lavender Hill and Khayelitsha, their presence as 'non occupational therapists' enriched the gathering with two additional generational perspectives and kept the professionals 'in check', and accountable regarding what was discussed and how it was shared. The proceedings needed to speak to them, to their everyday lives and the realities of their communities. In other words, for occupational therapy to matter, it needed to (also) capture their imagination and support.

Perhaps the most significant outcome of this unique two day gathering was the moment when one of the 'gogos' at the very beginning of the symposium asked in her mother tongue isiXhosa, "What does that big word on the screen, 'occupational justice' mean?" Although at that time we could have cited a number of working definitions (for example by Townsend & Wilcock), given that these would have to be translated into isiXhosa and seemed to be rather abstract and theoretical, the truth was that none of the occupational therapy professionals present seemed prepared to respond to the gogo's sincere fundamental question. So what happened? We basically 'copped out' and left it up to Vivienne Budaza, GAPA's executive director (who accompanied the 'gogos' and assisted us with translations and interpretations) to respond. You must know, she is not an occupational therapist, but has over the years developed a special appreciation (practical wisdom?) for the ways the occupational therapists at GAPA think and work. Remember our earlier exploration of a 'practical wisdom approach to making occupational therapy matter', experience seemed to be the source that Vivienne drew from when, after a brief pause of thinking on her feet, she offered the following response to the gogo: "Mama, occupational justice means all of us doing well with you ... doing well together." All the gogos, sitting at the first row in the auditorium, nodded, indicating: "That makes a lot of sense" ... prompting us that we ought to carry on with the symposium.

It can be argued that in his Foreword in 'Occupational Therapies without Borders: Towards an Ecology of Occupation-Based Practices' (Kronenberg, Pollard & Sakellariou, 2011), the South African Nobel Price laureate, Arch Emeritus Desmond Tutu also endorses a practical knowledge approach to making occupational therapy matter: "As occupational therapists you have a significant contribution to make [to the world] ... be inspired by Vivienne Budaza's explanation of 'occupational justice' as 'doing well together', allowing people from all walks of life to contribute meaningfully to the wellbeing of others."

Drawing to a close, a practical wisdom approach to making occupational therapy matter may require us to become (more) mindful of all that humans do and not do (!) with and to themselves and each other on an everyday basis, as it manifests on a continuum of affirmations and negations of our humanity, and as such may have implications for our health. Therefore, some 50 years after her 1961 landmark Eleanor Clarke Slagle lecture (Reilly, 1962), remembering and standing on the shoulders of a giant who passed away on 28 February 2012 at the impressive age of 95, I wish to offer a 21th-Century interpretation of the late Dr. Mary Reilly's oft-quoted hypothesis upon which our profession was founded--"Man, through the use of his hands as they are energized by mind and will, can influence the state of his own health" (Reilly, 1992): "Women, men, and children, through joining hands, as they are energized by mindfulness and political will, can influence the journey of their spiritual, social, mental and physical wellbeing."

Kia ora!

Acknowledgement

This paper is a modified version of the keynote presented at the 26th NZAOT Biennial Conference 'Maramatanga Hou--Fresh Perspectives' on 20 September, 2012 in Hamilton, Aotearoa/New Zealand. This privilege happened to coincide with the 6th birthday of our oldest daughter Masana Nelly.

Special note: After honoring Mount Fuji at WFOT 2014, please allow me to extent a warm welcome to you to join the world at the foot of Table Mountain at WFOT 2018 in Cape Town, South Africa.

Websites

Social Determinants of Health (WHO)--www.who.int/social_determinants/en/

Shades of Black Work--www.shades-of-black.co.za/

University of Cape Town--www.health.uct.ac.za/

Project Miquel Marti i Pol--jardimiquelmartipol.blogspot.com/

Grandmothers Against Poverty and Aids--www.gapa.org.za/

Isango Ensemble--www.isangoensemble.org.za/

Playing for Change--http://playingforchange.com/

War/No More Trouble/Song Around the World--www.youtube.com/watch?v=fgWFxFg7-GU

Barry Schwartz: Our loss of wisdom--www.ted.com/talks/barry_schwartz_on_our_loss_of_wisdom.html

GAPA 'The Nevergiveups' (Eric Miller)--www.youtube.com/watch?v=qUOUjmw3hgc & http://thenevergiveups.wordpress.com/

Links to Radio New Zealand interviews

www.radionz.co.nz/national/programmes/oneinfive/audio/2544535/one-in-five-for-27-january-2013

www.radionz.co.nz/national/programmes/artsonsunday/audio/2538129/south-african-theatre-company-isango

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Corresponding author:

Frank Kronenberg

Email: frank.kronenberg@gmail.com
Table 1
Juxtaposing dominant versus emergent occupational therapy
perspectives

Dominant traditional Maramatanga Hou--fresh perspectives
perspectives

* Occupational * Occupational therapies = Ecology
therapy = Monoculture of occupation-based practices

* Human occupation * Human occupation as a subject
as an object

"All the ordinary and "Humans are occupation"(Guajardo &
extraordinary things Kronenberg, 2013); "Embodied and/or
that people do every enacted humanity" (Kronenberg, 2012b)
day" (Hocking, 2003)
 Human occupation manifests on a
 continuum of 'benign' and 'malignant',
 a transactional interplay of factors
 pertaining to agency and
 structure (Kronenberg, 2012b)

* Western/Judeo-Christian * Ontologies/Epistemologies
ontologies/epistemologies of the 'South'

Privileging worldviews, * Inclusive of plurality and
knowledges, ways of voices--arguing for a more democratic
knowing from the European global recognition of worldviews and
and North American knowledges from the peripheries of
metropole (Connell, 2007, societies within and outside the
Kantartzis & Molineux, 2010) European and North American
 metropole (Connell, 2007)

* Apolitical * Political

* Medical Model * Social Determinants of Health

* Therapy--focus * Therapy--focus 'healing
'treating patients' relationships'

* Evidence: Empirical (EBP) * Evidence: Multiple methods

* Individualistic * Ubuntu ('doing well together')
('doing well)

* Institutional or * Health promotion, Community-Based
private practices Rehabilitation

* Neoliberal * Alternative 'sustainAbilities'
healthcare market

Public (government) and Social entrepreneurship
private health insurance
 Invitation-based practices: working for
 and through public, business or civic
 society sector organizations, not
 (necessarily) as 'occupational
 therapists', but carrying out
 occupation-based practices in
 response to the needs at hand.
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Title Annotation:VIEWPOINT ARTICLE
Author:Kronenberg, Frank
Publication:New Zealand Journal of Occupational Therapy
Geographic Code:6SOUT
Date:Apr 1, 2013
Words:7649
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