Prosthetics & Orthotics Volunteers: A First For Samarthya

Last year, I was at Hodgson Orthotics in Coquitlam to collaborate on a shared client’s scoliosis brace. I mentioned that I was heading off to India to volunteer, and joking-not-jokingly said, “I’m heading to India, anyone feel like coming with me?”.

Before I knew it, the ball was rolling and Yvonne Jeffreys (instructor at the BCIT Prosthetics & Orthotics Program and orthotist extraordinaire) was arranging a student placement for the second year BCIT students. Shane Bates and Malena Rapaport jumped at the opportunity to travel and volunteer abroad, all while completing their required clinical hours!

We quickly realized that it would be best to have a team stationed in Koppal and one in Deodurg/Raichur to spread the knowledge and provide the best working conditions for all four volunteers. We soon recruited Jenny Billett, a prosthetist working on the east coast, to be the other supervisor for the placement.

Soon after arriving in Koppal, the teams split up: Yvonne and Malena stayed in Koppal, and Shane and Jenny made the bumpy 5-hour journey to Deodurg. This is the first time the workshops have ever had technically skilled volunteers, so their contributions, suggestions, and insights were invaluable. In short (but kinda long), here’s what they did over 4 jam-packed weeks:

• The two teams observed their respective workshop processes and made suggestions to improve workflow and safety
• Jenny and Malena created floorplan suggestions to renovate Koppal and Deodurg workshops

• Ashok, Basavaraj, and Muttana shared their knowledge so the team learned about how to create aids and appliances in rural India using available supplies
• Shane gave an inservice on how to complete a thorough initial assessment, combining BCIT and Samarthya approaches
• Malena facilitated a group brainstorming activity to discuss four categories of concerns in the workshop – procedures, layout, resources, topics for learning. These will be the foundation for future changes
• Yvonne created a shared online folder and uploaded many resources for the staff to access, including device design flowcharts, manufacturing guidelines, and more
• Lengthy discussions with the local workers helped come up with a training plan for new technicians and assistants
• They identified equipment and tools that would improve efficiency, and last but certainly not least…
• They contacted their generous networks and received bags of donated tools and raised an astounding $5635 that will be going toward workshop renovations, equipment, and training!

A massive ‘dhanyavadagalu’ to Yvonne, Jenny, Shane, and Malena for everything!

Continual Evolution

It’s amazing how much the plans can evolve over the course a long project. One of the (many) lessons I’ve learned here is to adapt and evolve to each situation… particularly in India, situations change a LOT. Here is a continuation of the last post, describing our original goals and how they’ve changed.

Over the year of planning leading up to this trip, I really felt like a flaw of the aids and appliances workshop was the construction of wooden seating chairs that children would quickly grow out of, thus needing new ones within a couple years. So we came up with this goal:

#4: Increase efficiency of the organization by piloting and implementing new ventures such as a loan equipment program

After plenty of discussion with the workers, it turns out that a loan equipment program wouldn’t fly because it isn’t culturally acceptable to have your child re-use equipment from another child! Despite the low socio-economic status of many of the families here, people want seating chairs, walkers, and wheelchairs that are brand new! We scrapped that goal and had to go back to the drawing board for increasing workshop efficiency.

Goals #3 and #5 weren’t pressing back in the fall…but they certainly are now!

#3: Hold educational sessions for caregivers, school teachers, and other community members to maximize care and inclusion of people with disabilities in these rural communities.

#5: Teach the local CBR-Workers to be teachers, so they can continue to educate their colleagues and future newcomers to the field, and not rely on Canadian volunteers for education

We’re developing training sessions where the senior workers will be the instructors for the juniors, and talking about how to create effective presentations. The team has also already given 10-day training sessions to primary school teachers on how to identify children with disabilities and where to refer them for help!!

CBR Worker Viresh describing the different types of disabilities, and Virupakshi sitting in front translating into sign language

A very intriguing article was circulating on facebook (as they do) called The Differences Between Eastern And Western Cultures in terms of mindset. It is SO TRUE. I’ve seen these in action! The polarity in thought processes and general approaches to problems are bang-on, and there was one more aspect that perhaps applies specifically to Samarthya here in India. I’ve noted that most businesses in Vancouver have established extensive systems manuals to ensure that their business have structure and processes in place. What we found in the fall was that there weren’t any formal systems in place, and therefore this was causing so many issues! New goal:

#8: Create systems for processes that involve referrals between programs, because that’s where communication was getting lost. Establish formal job roles & responsibilities to minimize redundancies and gaps in service. Generate checklists to ensure information isn’t missed. 

The January Volunteers just finished up their time here – Next up: Below knee amputations, seating chairs, and AFOs – BCIT Prosthetics & Orthotics Team offers their expertise in the workshop

Project Update – Training Manuals

It’s hard to believe that half of the project is already over!! Apologies for the lack of posts – It’s been hard to document exactly what I’ve been doing because much of my role hasn’t been tangible.

To summarize, I came to India at the beginning of October with rough ideas of how our team of 16 volunteers could contribute to Samuha Samarthya in a sustainable way. Don’t get me wrong – Samarthya is doing an INCREDIBLE job, helping hundreds of children through their various programs. They are one of the most dedicated organizations in the state of Karnataka (and won an award last year for it!).

As an international volunteer, it was so tempting to fly in, help a bunch of patients, get that happy feeling inside because you’re helping these super-cute amazing kids and lovely adults, and then fly out, but that would have left the organization no better than when we found it.

Here were our original goals:

1. Improve the Community-Based Rehabilitation (CBR) training manuals (which haven’t been updated in 20 years!)
2. Hold theoretical and practical educational sessions for the CBR workers to improve and standardize the level of care being provided in the Early Intervention Centres, the Spinal Cord Rehabilitation Unit, and other community outreach programs.
3. Hold educational sessions for caregivers, school teachers, and other community members to maximize care and inclusion of people with disabilities in these rural communities.
4. Increase efficiency of the organization by piloting and implementing new ventures such as a loan equipment program
5. Teach the local CBR-Workers to be teachers, so they can continue to educate their colleagues and future newcomers to the field, and not rely on Canadian volunteers for education
6. Raise awareness of Samuha Samarthya by facilitating Canadian volunteer experiences (physiotherapists and orthotists). There are a total of 17 other clinicians and students coming for 1-2 month stints throughout the project!
7. Raise awareness for global health and create avenues for discussion about international volunteering in general, as I hope some of these volunteers may have the desire to contribute to other international projects. It is crucial to understand what type of volunteer work is beneficial for these types of NGOs, as we will be aiming to empower the local workers rather than doing the clinical work ourselves. We don’t want to parachute in, work, and leave, as that would leave the organization no different than when we found it.

Things changed from the second we hit the ground. It quickly became much more complicated as I peeled back the onion and found layers and layers of issues… and it took the whole first two months to really suss out what was happening at Samarthya. During that time, I really got to know the staff at a personal level and they shared their joys and challenges of their jobs. Through these conversations, I was able to gain their trust so they might be more open to our suggestions over the six month period.

Phase 1 (Oct-Nov): The first group of volunteers (Jen Tam and Julie Alexander) played vital roles in observing and inquiring about the technical skills, procedures, systems, and team dynamics. They asked why, why, why for each issue that came up, and found multiple levels which needed some work.

Here was the tricky part that applied to all goals: what level could we realistically affect in the 6 months to create a lasting change? Some issues were quick fixes (ie, implementing referral sheets to send clients to the workshop for splints) and some issues were stemmed as high as the board level. We couldn’t tackle it all.

Let’s look at goals number 1 & 2 for now – in October we started looking at the old training manuals and agreed that they needed to be updated. In addition, several junior workers had been hired recently and they hadn’t been trained formally yet in theory or practical skills. So as we were researching the information to update in the manuals, we were spending time observing and working with the CBR workers.

Challenge #1 – There wasn’t a standardized level of knowledge among the staff, so what was the appropriate level of difficulty to include in these manuals?

Challenge #2 – All CBR-workers were full to the brim with work and they wouldn’t have time to study these manuals. Why were they so busy?

Challenge #3 – Inefficiency. High-skilled people were doing low-skilled jobs; there was no designated administration person so the senior therapists were doing things like computer data entry, scheduling clients, and settling bills, and therefore clients couldn’t be seen. Additionally, it seemed like other processes were taking 2-3 steps more than required.

Because of this, seniors didn’t have time to train the juniors, and therefore the juniors weren’t capable to help with the high volume of clients.

NEW GOAL: Create a 6-month training schedules for the Early Intervention Center with set teaching modules for senior therapists to train the junior therapists in-house, so seniors could be free to do other much-needed work. Our goal is to streamline some Early Intervention processes = more free time for seniors = more opportunity to train juniors = spread out the workload and ensure a succession plan for the future.

Additionally, there were no therapists that were formally trained for the Spinal Cord Rehab unit. ADDED GOAL: Create a training manual and provide educational sessions about spinal cord injury to educate two new therapists who will run camps for men with spinal cord injuries.

Phase 2 (Dec): Physio Jen Waring observed and surveyed the junior workers, asked them what areas they wanted more knowledge in, updated a skeleton of the training manual and suggested a 6-month training plan. Physios Sarah Monsees and Larissa Vassos were based in the Spinal Cord Rehab Center and created a 30-page manual, starting with basic theory of spine anatomy, nervous systems, and more. They ran multiple evening teaching sessions a week that dramatically increased local workers Channappa and Meheboob’s knowledge and skills, and helped them run a 1-month camp for four men with spinal cord injuries. They also created exercise boards to help with compliance in the gym. 

The volunteers have exercised skills FAR beyond physiotherapy. We’ve been challenged with curriculum development, teaching, organizational development, people management, budgeting, and of course, doing all of the above across a language barrier.

Thanks Jen, Sarah, and Larissa for ensuring success in Phase 2!!

Next update: Scrapping goal #4, delaying goals #3 & 5, and adding very important goal #8!

Functional Adaptation for Familiar Faces

Two years ago, I had the pleasure of meeting Gousiya, Mustafa, and Abdul, three siblings who are all diagnosed with muscular dystrophy. With donor funding, we were able to provide their family with a wheelchair to transport the kids to and from school, a small desk to enable them to do sit upright while doing homework, and splints for Abdul, to prevent progression of his calf contractures. Read their full story, and learn about muscular dystrophy here.

In my first week back, I discovered that Samarthya has continued their involvement with this amazing family by funding and orchestrating the construction of a toilet!

Abdul, Gousiya, and Mustafa (L-R0, Oct 2015

Previously, their mother Rashida was carrying each child to their uncle’s home (nearby, but still inconveniently far enough) to use the toilet. As the children have grown, this became increasingly difficult for her, eventually causing her severe back pain.

Samarthya’s Functional Adaptation Program, with lots of work from the German volunteers Fabian and Jonas (who produced the summary below), improved the quality of this family’s day-to-day lives by alleviating some of Rashida’s physical demands. If you want to see the process, or if you happen to want to learn how to build an Indian out-house, check out the photos below!!

Wanted: CBR-Worker. Qualifications: Not What You Would Expect

In Canada, applying for a job is a competitive and often rigorous process. In the physiotherapy world, employers typically seek the following qualifications and traits:

• Sufficient educational background consisting of a Bachelor Degree (any field) and a Masters in Physical Therapy
• Strong experiential background, particularly in the area of hiring interest; for example, when hiring for a position in Spinal Cord rehab, previous experience with neurological conditions is highly preferred
• High level of ambition, drive, motivation for continual learning
• Any extra contributions to the company; for example, intentions to spearhead new programs, volunteer with community events, etc
• Ability to communicate and relate to colleagues, superiors, and patients and their families

Our plans for sustainability include shifting two current Samarthya staff to the Spinal Cord Rehab Center, and we’ll be sending them for more formal training with APD in Bangalore so they will be better-equipped to provide higher quality care to more clients at the center. Here was the eye-opening thought process for selection of the two rehab assistants:

• First, the chosen staff had to be male. In rural India, traditional values are still strongly present in the culture and therefore it’s inappropriate for a woman therapist to work with male clients.
• After ruling out women, there were five people who were candidates. We asked the two most senior staff if they were interested, and one clearly stated he did not want a lead role, and the other said that ‘he would be happy with anything’. People-pleasing and saying ‘yes’ to anything and everything is common. The other three also said they would be happy in any position.
• A specific educational level is not required, but an ability to read, write, and learn were key. A couple staff had bachelor degrees, and therefore had experience with studying. Many of us have figured out techniques to facilitate our individual learning – from cue cards and lists to anagrams and cartoon doodles.
• Previous experience wasn’t a factor – one staff member was trained in social sciences, one in horticulture, and one in arts. Each had some exposure to therapy work in the recent years. We would be sending the staff for training from scratch so the previous point weighed in more.
• Next we examined each staff member’s projected commitment to Samarthya – how many years they’ve been working there and their intentions for staying around. We learned that government positions are rarely available but highly sought after. Even though the salary is lower, job stability and pension is higher. Many people would leave immediately if they were accepted into a governmental position. One of the staff has openly expressed that he’s applied to the government, so he became a less favourable choice as these positions will be a big financial investment for Samarthya, and will demand plenty of study time and effort on the staff’s part.
• Then we had to take into account if they were married. If he was single, was his future wife ‘fixed’ (is the woman already chosen)? When was his wedding (would it be in the mdidle of training)? Which village would they live in after marriage (we need someone living locally)?

India Weeks 3-4: Progress at each campus, and farewell to Julie!

It’s hard to believe a month has flow by already, and that volunteer Julie’s time at Samarthya has come to an end!  As we stated before, our goal is to further develop and strengthen the centers in the four following campuses:

The Early Intervention Center in Koppal is a well-oiled machine. The Senior CBR-worker Prabhakar is highly skilled with the children, and is focused on providing education for the families. He truly strives to empower the parents to be the driver of their own child’s healthcare, and tries to decrease their dependency on him. Julie had several discussions with him and suggested some time-saving strategies to make him even more efficient. She created an exercise sheet template to increase parent compliance and decrease his stick-men drawing time. She also discussed the possibility of implementing group sessions, as many of the children present at the same stage of development.

Prabhakar’s dream is to have multiple clinic spaces (currently only one treatment room) staffed by three assistants, and to hire a recruiter to visit villages, meet with doctors and other health care professionals, and provide simple education sessions to surrounding community members.

The Early Intervention Center in Deodurg needs quite a bit of help – it seems like operations are all over the map. Volunteers in December will be dedicating most of their time to analyzing the processes and suggesting some time-saving strategies to also appropriately increase the reach of the services in the area.

In Raichur, we are hoping to launch an Early Intervention Center!! Raichur is a town of 200,000 people and there are NO services for young children with disabilities. Currently there is a workshop there that is struggling for business. We’re trying to estimate the cost of this start-up which can then contribute to the workshop orders, and luckily we have two existing successful Early Intervention Centers to base our plans on.

Senior Workshop Technicians Basuraj (L), Ashok (R), and CBR-Worker Babumiya (middle) dream to have busy, smoothly running EICs in Raichur and Deodurg and an efficient workshop set up to allow them to serve more villages in these areas. They also wish for a mobile workshop (via a kitted-out van or autorickshaw?!) to bring services to those who can’t come to them. Imagine that!

Here are a couple of photos of the current workshop – we’re hoping to move the main manufacturing center to Deodurg, have only a satellite clinic in Raichur, and use the existing bright and colourful space for therapy for little kiddos!

The Spinal Cord Rehabilitation Center currently needs the most attention. There aren’t any fully-trained therapists working there and it’s currently running a major deficit due to low attendance. The main reason for the lack of patients is that most families cannot afford the Rs.4000/month cost ($80CAD) even though the patients would really benefit from the service. Also, a lack of an on-site medical professional make it even less attractive.

Physio volunteer Jen Tam has travelled along very bumpy village roads to do home visits for patients with spinal cord injuries and has been observing the current “short-stay camp” – a week-long camp for 7 old and new patients (see photos below) to get together and review exercises and gain support from their peers. Jen has come up with several great ideas:

• hiring a part-time nurse to care and educate staff and patients on wounds
• having a day of ‘stations’, where patients get to try various vocational and leisure activities (instead of just talking about the possibilities). Some ideas include caring for chickens to produce eggs for income, learning how to garden while being in a wheelchair, and learning to play wheelchair basketball
• holding short-stay camps several times per year versus trying to recruit patients for 3-month long stints

We’re choosing two staff members to send for a 10-month distance education training program through the Association for People with Disabilities (APD) based in Bangalore to really increase the quality of care that we provide for these vulnerable clients.

One more round of thank-yous to Julie Alexander, who’s creativity and problem-solving skills contributed highly to this project!

Next up – what factors do we need to consider when making human resource decisions in a rural Indian organization?? Hint: it’s verrrryyyy different than hiring and firing in Canada!

Phase 1 – The Big Picture

After having several meetings with Hampanna, the director of Samarthya (the sector of Samuha dedicated to helping people with disabilities), we established that the main goal over the next six (almost five!) months is to strengthen the existing programs and increase their sustainability. The programs are:

• Koppal Early Intervention Centre and Workshop
• Deodurg Early Intervention Centre and Workshop (4 hours north of Koppal)
• Raichur Workshop (4 hours northeast of Koppal), and a non-existent but much-needed Early Intervention Centre
• Koppal Adult Spinal Cord Rehabilitation Centre (the only one of it’s kind in the area)

Prior to any planning or analysis, our team wanted to connect with local staff to gain a deeper understanding of their programs’ goals, structure, workplace dynamics and culture, and of course, to further understand ‘rural Indian’ lifestyle and culture.

We asked some ‘big picture’ questions to see how the CBR workers and technicians viewed the current state of their programs:

1. What is your role? What tasks are you responsible for?
2. What the your favourite part of your job?
3. What is your least favourite/most frustrating/most difficult part of your job?
4. What is your program doing well?
5. How could your program improve?
6. What would you like to see change?
7. What goals do you have for your career?
8. How would you like Canadian volunteers to be involved in the growth of your programs over the next 6 months (if at all?)

I’ve had ‘big picture’ conversations with many of my friends and colleagues at home, and those who know me would agree that I like to ask the question, “In an ideal world, with no limitations – what would you do for the rest of your life?”.

I LOVE the thought-process and conversation that this question stimulates, and the insight one can gain about a person (or about themselves) from their answer. So, we modified this question for the project:

    9.  In an ideal world with no limitations, how would your program run?

The staff are often overwhelmed with work that they rarely have an opportunity to voice their true concerns and opinions to their colleagues or superiors, so we hope to create a platform for them to do that with these conversations. We were astounded by their creative responses and ability to express their core desires, and now we just need to explore the ‘how-to’ to make it happen. 

We want to encourage them to dream. To create a vision. Because “clarity precedes mastery and it’s impossible to create an outcome/goal/result that you can’t even see”. – Robin Sharma

Dream. Articulate. Plan. Achieve.

India Week 1-2 – Fundraising success, Shopping, Koppal, Frustrations

During our first couple weeks here in India, we have already experienced so many ups and downs!

Firstly – although the final count is nowhere near final, we have REACHED OUR GOAL and collected over $10,000 in contributions!! Many volunteers still have to pass along some donations, so THANK YOU to every single person who gave everso generously.

We gathered a few last minute supplies and snacks in Bangalore, then hauled all of our stuff to the train station, and were rocked to (not-so-deep) sleep on the 10-hour overnight train to Koppal, and were greeted by smiling familiar faces at the train station! From there, we took the most common form of transportation back to Samuha – motorbikes!

We spent the first few days getting ourselves sorted and ready for our time in Koppal. Big realization: nothing in India runs as smoothly as one would hope. We bought only one ready made outfit each in Bangalore, with the intention that we would custom order the rest of our clothing made locally in Koppal to support the economy.

One of the first evenings, we ventured into town with the cook (who can also sew), and two other female CBR workers. There are also three German volunteers here for the year, so they came for the trip into town as well. We packed 11 people into a 7 seater micro-van. So we took a selfie.

We went to three different fabric shops and became overwhelmed with the choices being thrown at us (literally, they were throwing stacks of dresses at us), then another shop to purchase lining fabric, then yet another shop to buy thread. The whole affair took us three hours. But, Ruksana (the cook) created beautiful suits for us to wear during our time here in only two days. Each set cost $22CAD, materials and labour all in.

The next example of how things don’t run as smoothly as you’d hope: when I say that my patience was tested these past weeks, that is an extreme understatement. Much of the reason that I haven’t updated this blog was because I was dealing with visa issues – when I applied for my employment/volunteer visa in Vancouver, I listed the Samuha Bangalore address on the application (as that is the official registered office). They granted my visa as above but when I went to register with the immigration office (which I had to do since I’m staying a longer period), they strictly told me that I was only allowed to live and work in Bangalore, and therefore not allowed to work in Koppal, where I need to be.

We tried everything – I stood in line after line, travelled back and forth to Bangalore, filled out forms, Samuha directors wrote me new sponsorship letters, I pleaded with several different officers, and Samuha even sent in one of their main contacts to speak with a higher level officer. At the end of it all, we had two options: a) IF the Vancouver office amended the visa to change the location from ‘Bangalore’ to ‘Koppal’, then I could stay; or b) I would have to leave the country, fly home to Vancouver, and re-apply for a new visa then fly back. I sent a few emails to request the change, but ultimately it was with the help of my dear friend and Kids Physio colleague Sharaya who physically went to the office, explained my situation, and was able to get a Consular officer there to grant the change. I CAN STAY!!

I cannot express my gratitude enough to each person who worked so hard to keep me in the country – from the drivers bringing me back and forth to the office, the staff for writing last minute letters, offering support and calling in help, and of course Sharaya for taking time out of her busy day to go to the visa office on my behalf.

SO – project-wise, what have we been up to? Well, after a few exciting sessions of brainstorming and planning, the ball is rolling on how to improve the programs of the Early Intervention Centre in Koppal (main town), the Early Intervention Centre in Deodurg (3 hours away from Koppal), and the Spinal Cord Rehabilitation Unit (45 minutes away from Koppal). Those details coming up next!!

Fitness Fundraisers!!!

We had HUGE success during the 2014 fundraising campaign from our two fundraising events. As a physiotherapist, these were the best events possible in my eyes: the participants got up and MOVING, the talented entrepreneurs Francis Dos Santos and Carla Rogan were able to showcase their skills, and we raised a total of $450 for Samuha Samarthya – it really was a win-win-win situation. This money went directly to Koppal, India, and Samuha was able to purchase some much-needed therapy and mobility equipment for families who couldn’t afford it.

It was a no-brainer to run these two events again this year, so here’s the info!! RSVP to andrea@kidsphysio.ca to register for either (or both!) of these events.

FIRST UP: Francis Dos Santos is holding a high-energy bootcamp class at GroundWork Athletics. Get ready to sweat, pump up your heart rate, and burn some serious calories!

NEXT: My dear friend Carla Rogan will be holding a yoga class at Make, the creative agency where she works. The gallery is an open space with high ceilings and this yoga class is a perfect combination of flexibility, relaxation, and strength, and will be a great way to kick off the weekend!!

YOU can be the change!

2015-2016 Samuha Samarthya Sustainability Project

We have been so grateful that many of you have asked how you can contribute to this project. Well – here’s your chance!

Our fundraising campaign is aiming to raise $10,000 for the 2015-2016 Samuha Samarthya Sustainability Project starts today, and wraps up on September 30th!

Please visit the DONATE tab for full details on how the money will be used. 

In order to avoid administrative fees imposed by fundraising websites, we will be collecting donations via direct deposit to the following account that we created specifically for this campaign. Donations of more than $20 are eligible for a charitable tax receipt.

Please include your email address in the “Message To Recipient” box so we can contact you to say Thank-You and get more details to send you a receipt if you’d like one.

Interac E-Transfer: andrea@kidsphysio.ca
Transit: 02800
Institution: 010
Account #: 8844739
Swift Code (for International Donors): CIBCCATT

If you aren’t able to make a financial contribution, we completely understand – we would appreciate any help to spread the word about our cause in any way you feel inclined. Talk, text, Facebook, Tweet… we would be so SO grateful for it all. 

THANK YOU for your support.