OCCUPATIONAL THERAPY: AN INDIAN HISTORICAL PERSPECTIVE

The founding of the profession of occupational therapy in India &Asia came about from the very deep & personal feelings of Mrs. Kamla V. Nimbkar [nee Elizabeth Lundy] towards her adopted country, India. When she first met her future husband in America at the international House in New York & they got engaged, both felt that she should make some contribution towards the social upliftment after coming to India.

She had obtained a B.A. in Economics Statistics from Columbia University. Her first attempt at making some contribution took her to U.K. to study Kinder gardening [Frocbel Method] & she returned to start such schools in India. One of them grew under her personal management to a full high school with 450 children & a staff of 26. It was felt that the school could progress faster & get more official assistance if it was run by a society & so it was given over to the Bombay Suburban Education Society & today it is a big high school with over 1500 students.

Mrs. Nimbkar came across an article on Occupational Therapy by Miss Helen Willard, the Head of the Philadelphia School of Occupational Therapy [later joined with the University of Pennsylvania]. Mrs. Nimbkar realized that this was something India did not have but needed. It would contribute to the welfare of thousands of patients as well as create a profession. Hence at the age of 45 Mrs. Nimbkar went back to the United States, & enrolled for Occupational Therapy course at Philadelphia school of Occupational Therapy.

Mrs. Nimbkar commuted from her father's home an hour by train & then 20 or more minutes by tram to the Occupational Therapy School. She did not find it easy to go back to studies, but realizing the purpose, staff members very keenly helped her in completing the task. Between the classes & clinical training period Mrs. Nimbkar returned to Mumbai & contacted Dr. Dyagude the then Dean of Seth G.S. Medical College & K.E.M. Hospital who became most interested in her project & was ready to help.

Subsequently having completed her training, it was arranged with the municipality under the backing of the then Commissioner Shri. P.R. Nayak, that a year of demonstration of just what was Occupational Therapy & what it could do for the patients. Work started in the Orthopedic ward under Dr. Katrak & in the children's ward.

Also the dimension of mental health was focused by therapy. Due to increased stresses & strains due to modernization in urban areas man became more prone to mental ailments; therapy played an important role in aiding diagnosis, facilitating the patient's adjustment to hospital environment, and habit training. The treatment principles were addressed on behavioral modification & psychoanalytic frames of reference. Patients are helped not only in hospitals but also later for social adaptation through group therapy & counseling. Work fitness assessment is carried out in later stages to facilitate financial independence in every day life.

Also academically as Occupational Therapy education became incorporated to universities instead of free standing schools, entering the realm of degrees & postgraduate programme, new questions arose regarding how the knowledge from our field could contribute to the wisdom represented by university? Hence appropriate revised curriculum was worked out to meet the changing need of people.

The advancing changes in the health care system during last few years have reflected in the development of new paradigms in the field of occupational therapy. Therapists' are using preventive therapy dimension in gericare, early intervention therapy in developmental disabilities & Community Based Rehabilitation [C.B.R.]. Indian therapists have realized that western models are not suitable for our society & are using pragmatic C.B.R. models in communities, schools, & places of work .These essentially involve various dimensions of functional restoration, environmental modifications &use of local artisans for appropriate technology.

During last 50 years Indian Occupational Therapists have nurtured the domain of rehabilitation by productive & pragmatic research. These contributions ensure that the entire profession, its practice kept growing serving humankind & communicated the essence of its service to the persons with disability to improve their quality of life.

Thus some where in 1949 it was a common site in the corridors of K.E.M. hospital to see an American woman wearing Indian sari & hospital coat , moving with odd looking things , strings & frames in her hands .The lady was none other than Mrs. Nimbkar & odd looking things were treatment media of Occupational Therapy.

After a year the work was appreciated so much that a committee from municipality & the K.E.M. hospital authority decided to approve the Occupational Therapy project for a school & center with Mrs. Nimbkar as Hon. Director. On November 14th 1950 Smt. Rajkumari Amrit Kaur, then Minister for Health, Govt. of India, inaugurated the center, & the certificate course in O.T. began. Thus in 1950 the First school in India & Asia was started at K.E.M. hospital, which received recognition of the World Federation of Occupational Therapy, & became one of their founder members in the year 1952.

Mrs. Nimbkar retired from the Occupational Therapy School, Bombay in 1957. Prof. [Mrs.] M.M. Shahani led the institute to further progress after that. Many students from Ceylon, Malaya, & Indonesia, & other south east countries were trained at this institute to spread the word of occupational therapy in other parts of Asia. In 1967 two years diploma course got affiliated to Bombay University. Later it got extended to three & half years. First Master's programme in O.T. started in 1979 with affiliation to Bombay University. This gave rise to research dimension to O.T. in India.

Mrs. Kamala V. Nimbkar was invited in 1958 by the Govt. of Maharashtra, to establish a second school at the Govt. Medical College & Hospital, Nagpur. Realizing the need of O.T. professionals, other states in India started O.T. schools at New Delhi in Northern India & at Christian Medical College, Tamilnadu in Southern India. Gradually realizing benefits to health care other states started Occupational Therapy schools in different regions. Today after 50 glorious years of its services in India, there are 14 schools imparting O.T. education & many more are on the anvil.

Till 70's Occupational Therapy awareness was only in the fields of amputations & paraplegics of army hospitals, leprosy, T.B. & mental illness, which were the common debilitating ailments of those times. At that time therapy revolved around diversion, recreation, & occupational independence. This occupational independence was confined to sanatoria or hospitals where these patients stayed, as there was a lot of social stigma attached to these ailments. It is only during last 2-3 decades that more stress is being laid on social rehabilitation & financial independence which led to development of splints & adaptive devices & planned exercise regimen for restoration of original functional ability of the person.

Due to the industrial revolution the incidence of accidents & injuries increased & Occupational Therapy departments were established in all major hospitals. Vocational rehabilitation centers were also set up as many of the industrial injuries were such that they would not regain full functional recovery. Thus therapists had to treat these patients as well as to evaluate & assess the percentage of disability which allowed the patient to demand compensation. In case the patient could not go to his previous job it was necessary to give him prevocational training & get him effectively rehabilitated.