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

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!!final feedback report-page-002 final feedback report-page-003 final feedback report-page-004

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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:

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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.

IMG_6333Prabhakar’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!

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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!

IMG_3585 IMG_3586The 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

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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!

farewell julie

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!

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!IMG_6184 (1)

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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.

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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.

dresses

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!!

On the Road Again

ad·ven·ture
adˈven(t)SHər, ədˈven(t)SHər/
noun
  1. an unusual and exciting, typically hazardous, experience or activity.
Last fall, I was getting an itch for adventure and a desire to take on a new big project. After exploring several options, I decided to head back to the place that so heavily influenced my career and my life – Samuha Samarthya in India! It will certainly be an exciting (but hopefully not too hazardous!) experience, and undoubtedly the largest venture I have ever undertaken to date.
samuha
This will be my third volunteer trip there, and my role is evolving once more as I’ll be staying for 6 months. In 2011 I was a physio student, in 2014 my role as clinical preceptor allowed me to take another physio student, and in October 2015 – March 2016 I will be focusing on the education piece and working as a coordinator to help facilitate Samuha Samarthya’s growth.
The main goal of this trip is to improve Samuha Samarthya’s sustainability. We hope to contribute to this by:
  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.
Stay tuned over the coming months for updates on volunteer profiles, details fundraising events, and play-by-play action while we’re there. Thank you to everyone for your support so far!
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