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 workshopsIMG_4785
  • 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 approachesIMG_4731
  • 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 changesIMG_4768
  • 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!

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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. IMG_4449

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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!

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.

clarity

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!
 global health image