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!!

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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

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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!

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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!!

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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.

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Movement 101 Workshop – Richmond

Physiotherapist Sarah Stroh is one of my nearest and dearest friends. We have a long history of having conversations about our passion for teaching people (children and adults alike) how to properly move their bodies to prevent and rehabilitate injuries. After coming to a realization that we were delivering the same messages to our clients day in and day out (how important it is to breathe, what exactly your ‘true core’ is, benefits of squatting and crawling and hanging, etc), we thought, hey – why don’t we offer a workshop where we can deliver our message to lots of people all at once BEFORE they come into the clinic for pain and dysfunction?

After many weekly meetings, exciting discussions, play dates, and coffees, here it is: Movement 101.

Sarah’s incredibly detailed observation skills for movement patterns, yoga and pilates training, plenty of research on breath and core, and a continuing passion for helping adults move better

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Andrea’s knowledge of neurodevelopment and children’s physical abilities, and high level of creativity for fun movement games, and also a continuing passion for helping kiddos move better

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Our various experiences and education from courses and physio mentors combined

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The most effective and fun ‘exercise-less’ movement morning happily delivered by two enthusiastic and smiling physiotherapists 🙂

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The Puzzle of Pediatric Physiotherapy

(Originally published on OrthoCanada’s blog, July 29, 2014 – here)

Physiotherapy is a never-ending puzzle. That’s the challenge of this profession – we are constantly being driven to expand our anatomical and functional knowledge, amp up our kinaesthetic abilities for assessment and treatment techniques, and cultivate our movement creativity.

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In 2011, I completed the Master of Physical Therapy program at the University of British Columbia, and graduated with similar knowledge and experience to the other 66 students in my class. I was given the opportunity to work at Kids Physio Group, the first private paediatric clinic created to serve the greater Vancouver area. Entering the world of pediatrics right after graduation was daunting, as I was concerned that I didn’t possess enough pieces of the puzzle to enter this realm. I felt I hadn’t learned sufficient anatomical or functional knowledge regarding a kiddo’s growing body, nor was I prepared with any specialized treatment techniques for the plethora of pathologies that might present in the pediatric world. I also didn’t think I was very creative (as I believed I was always more “left-brained” and factual). Needless to say, I was hesitant to start a career in such a specialized field. Now, after three years of working at this unique facility, I realize that the physiotherapy aspect of this job is only a small piece of what makes paediatric physiotherapy such a puzzle.

The complexity of cases in paediatrics never ceases to amaze me. This past spring, I met an amazing 4-year-old girl who was born to a substance-abusing mother. She and her twin sister were adopted into a phenomenal and passionate family who goes to great lengths to give them all they need and more. This young girl was diagnosed with diplegic cerebral palsy, has an array of serious gastric issues and associated surgeries, and is completely hearing impaired (which has led me to late-night googling of physio- and play-related sign language and using my NetFlix account to access “Signing Time”). I’ve learned to quickly set up a puzzle, stabilize this squirmy child’s pelvis to help her step up onto a box, and simultaneously sign “Great job! Again!” ten times in a row while wiping my glistening brow in between reps. And despite all of the challenges she faces on a daily basis, this girl is a determined and strong-willed child whose cheerfulness is infectious, and I look forward to problem-solving all aspects of her treatment and learning from her every week.

It’s slowly becoming clear to me that family structures and social dynamics are complex and can strongly contribute to a child’s success in a rehabilitation setting. As a late-twenties young professional who has very few friends with children, I had to dig deep into the memory bank to empathize how it might feel to be in highschool at 15-years-old, living under my parents roof, and worrying that if I might not be a part of the popular crowd if I didn’t make the cut for the volleyball team because my physio told me to rest my knee. I’m understanding that kids are pressured from all directions – school, peers, sports, and home – and these puzzle pieces need to be taken into account as I create my overall treatment plan.

Many therapists may agree that perhaps the largest puzzle piece in paediatrics is solidifying a child’s buy-in and compliance to complete an activity that causes discomfort in the form of pain or difficulty. We see many children and youth of all ages that require a regular stretching program, but as many of us know, stretching is uncomfortable and boring. Similarly, some children present with lower muscular tone than average which limits them from participating to the same level as their peers. A regular strengthening program is the typical course of action however the trick is to devise a series of games or activities that encourage the child to complete the recommended sets and reps despite ‘feeling the burn’.

Additionally, I’ve learned that it’s crucial to establish authority within the first few sessions to maximize the therapeutic relationship between myself and the child. Building a solid sense of trust through exciting games, meaningful conversation, and fulfilled promises for rewards and end-of-session “Thomas The Train” stickers leads the child to happily participate throughout the intense 45-minute treatment session.

Pathologies and conditions certainly differ between the adult and child populations, but paediatric physiotherapy is so much more than the anatomical and physiological side. It is an art that combines mastering behavioural strategies, possessing continual ingenuity for games and obstacle courses, and having an ability to relate to any child regardless of their age, cognitive ability, or physical state. Nothing in school could have prepared me for this extensive puzzle, as I’ve found that much of this can only be learned through on-the-job successes and even greater failures. I still get a bit nervous when a new assessment walks through the door, but get excited as I start to unfold various pieces of that puzzle. After all, it is fascinating to witness the progress that evolves when those puzzle pieces come together and overall picture of a child becomes apparent.

Cultural Impacts on Health in rural India

January 13, 2014

We are now starting our second week at Samuha, and have had a good chance to interact with the local workers, staff, and families. We’re starting to realize that health issues in this part of the world are more complex than simply diagnosing ailments, diet, and medications. Cultural norms have an incredible impact on the prevalence of conditions, and often solutions that would be considered ‘simple’ in the western world are certainly not-so.

Many people believe that only doctors, injections and other medications can help their child, and rehabilitation or exercise is not a widely known concept. Parents will spend thousands of rupees looking for a cure or quick fix.

Toilets are non-existent in villages, so there is often resistance to installing one in a home despite the tremendous need of a person with disabilities. There aren’t any plumbing systems therefore the community would have to create a system just for that family.  Things are changing though: there was a recent court case where a woman left her husband because he refused to install a toilet in their home. The court ruled that he had to install one within 150 days or pay a fine.

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Co-sanguineous (aka within-family) marriages are common, with more than 50% of families having this set-up.  The most known pairing is that a girl will be set to marry her mother’s brother. Many of the children that we’ve seen come through the clinic have very young mothers (between 15 and 20) and a much much older father.  Another common marriage set-up is between first cousins. The age gap is much less but the bloodline is still close. For those who haven’t taken genetics courses in university, reproduction that occurs within similar bloodlines increases the chance of recessive traits being expressed – in layman’s terms, many conditions are seen in co-sanguineous marriages that would not otherwise be seen with a mixing of totally different genes.

There is still a difference in the level of social acceptance of male versus female. Women here have an abundance of responsibilities: they farm, clean, cook, shop, and take care of the children.  Despite this, the females will eat after the males have finished in some households, and therefore are malnourished. An unhealthy woman will then have difficulty producing nutrient-rich breast-milk, leading to a malnourished baby.

 

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In general, mental or physical disabilities are taboo and these people are often neglected – those with special needs often stay at home, don’t seek therapy and as a result suffer consequences of their disability (contractures etc). There are some positive changes happening – the government recently passed an act that disabled children who attend a public school will receive financial support, starting at 700 rupees/month. This is a great step in the right direction, but even if these children attend public school, they won’t have adapted equipment or individualized education plans as we do in Canada.

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It’s important for us to realize that we can’t come to Samuha and change the culture. We’re here to share our knowledge and create positive changes where we can, learn about commonly-seen issues and improve our hands-on skills from the local workers, and we’re encouraged to hear that health policies and general attitudes toward disabilities are improving everyday.

Samuha Fashion Week 2014

January 11, 2014

Over the past week we’ve settled in to the lifestyle at Samuha, and are pleased to present the 2014 line up of Samuha Fashion Week!

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Danielle sports a vibrant printed blue kurti (shirt), adorned with patterned colourful stripes. She pairs this with flowing navy hammer pants and completes the outfit with a fun fuchsia scarf. It is stylish yet comfortable – the perfect combination for work at Samuha.

 

 

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Marcia brings a little bit of the western Christmas culture to Samuha with this festive salwar kameez (full matching outfit). She goes against the grain with a fiery red pant, peeking out beneath her printed rouge-et-vert chemise (pardon my French). Printed ribbon and red sequins complete this look, and the scarf is must-have.

 

 

 

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For her daytime attire, Kailen chooses to stay in the cool colour palette with a sophisticated blue kurti, striped beige and embroidered with indigo flowers. To complement the flowers, she wears the fashionable ali-baba pants, which keep her cool – both temperature-wise and style-wise.

 

 

 

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Bold patterns are all the rage this season. Maegan shows how versatile this outfit can be – it can be worn to a casual dinner with friends (us), business meetings with colleagues (also us), out-of-office occasions (home visits with us and clients) or Saturday morning yoga class (with the rest of us)! She has carefully chosen to accentuate the playful pink buttons by selecting a perfectly matching pant and scarf. In fact, the scarf uses the ombre effect to fade from fuchsia to beige.

 

 

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Great fashion sense never goes out of style. Andrea demonstrates this by sporting a rich, rustic red salwar kameez that she carefully chose during her visit three years ago. Despite being from a few spring cycles back, this unique colour combination perfectly matches her skin tone. Note the carefully embroidered floral deco on the pant, a detail that makes all the difference.

 

 

 

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