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Encouraging a child to draw on paper. I don't know if he has ever held a pencil, but he had fun trying! Monday
Today we encountered some frustration and discouragement, as reality has begun to sink in about how much we will really be able to accomplish. After today we now have 4 more days left at the orphanage, and so much to do. Next week we are going to be at the neurological hospital for children.
This morning started with an opportunity to use our flexibility and go with the flow skills. Our interpreter was called to a meeting at the last minute this morning, as some MTI staff are leaving tomorrow and a project proposal for the next fiscal year has to be finished before they leave. We sensed some stress at the MTI office as we left 45 minutes late to the orphanage without an interpreter. We couldn’t do our seminar training, and the 30 caregivers who were waiting for us in the room hadn’t gotten the message that we were planning to do the training in the afternoon, and seemed disappointed. So we went up to the laying down and sitting up rooms and many of the children were laying out on the porch. There were, however, many more toys available for the children to play with
today, so this was encouraging! We tried to accomplish a few official evaluations on the forms from Disabled Village Children, but the caregivers who were there were expecting some trainings so we mainly moved from child to child attempting to get children to engage with us, with toys, and adjusting their positioning to attempt to sit some of them up. We worked for a couple hours on two different units, demonstrating techniques to the caregivers when we could. I began to realize the extent of the situation here at the orphanage, with so many kids, so many individual needs, not the right equipment available, and so much already accepted as protocol as to how the kids spend their day- although more active in the morning, we learned that the 3 hours in the afternoon are spent “napping” when the caregivers leave and the children lay alone in their rooms with nothing to do but stare into space and some of them make sounds. I learned this when going back up to get something I left after lunch.
On a more positive note, we felt that many of the caregivers were eager to learn from us, and although it was
difficult without an interpreter, we managed to get across some messages to them about our recommendations for the children. It was pretty amazing to see the joy in some of these kids (the ones who can communicate) despite their situation. And we have to keep reminding ourselves that this orphanage, it’s children, and it’s staff have come a long way in 10 years.
Our hopes for spending the afternoon at the orphanage, however, probably won’t work out due to the orphanage’s strict protocols that the children “rest” during the hours between 1:00 and 5:00. Due to our schedules and transportaion, we are unable to come back after 5:00. So we will have to do as much as we can in the time that we have with them- between 10 and 1 am. We are still used to our strict western schedule and long working hours, and feel like we need to be there longer and get more done. So we will use the afternoons to plan, discuss, and communicate our recommendations with MTI staff. We got the chance to meet with Shukhrat this afternoon, and learned a lot about the past and future of this orphanage project and a
Child going in for a punch
We worked with these kids on feeding later, and I may be able to upload a cute video of them trying to feed themselves for the first time. new related project which will take place next year. I will talk more about that later this week. I will say, for any OTs, PTs, nutritionists, speech therapists, audiologists, special education teachers, or other medical staff out there reading this there will continue to be opportunities here in the next several years, so if anyone is interested, let me know and I’ll give you contact information! There is also an ongoing EMS project going on here with MTI-
Enjoy the pictures, more to come. Verse of the day:
“For the foolishness of God is wiser than man’s wisdom, and the weakness of God is stronger than man’s strength.” 1 Corinthians 1:25
Tuesday
It’s been a mind expanding thing being here, not only because I am constantly reminded that there is more than one way to do things, but also that because just because I as a westerner think a certain way is best, doesn’t mean it is, and if I tell someone that something should be done a certain way doesn’t mean they will do it or they should do it. I’d like to think that all these recommendations we give to the caregivers will actually
take effect. The easy part is telling them what should be done to care for the kids. It’s satisfying to leave a seminar and know you’ve given them a bunch of good information, and hope they have the understanding to carry out the recommendations. A harder thing is demonstrating it to them in practice in the childrens’ rooms, as we are faced with the reality of the extent of these childrens’ complications. An even harder thing is returning to the childrens’ rooms when they are not expecting us and finding that they are continuing to practice their care in the way that makes themselves and the children the most comfortable, but that does not promote further development and improvement in the children. As therapists, who know that the most comfortable and easy way often isn’t the best way, this is frustrating! We brought a bunch of wedges up out of the therapy room today into the childrens’ rooms to give the caregivers easy access to a tool that will allow the children to sit up for an amount of time during the day creating a more therapeutic environment for the kids all day long. The caregivers were reluctant to tell
Children on the porch
We're trying to encourage these children to sit up, as many of them can with help. us that the wedges needed to be returned to the “therapy room” It seems that in their minds, therapy is only done in the “therapy room,” but how can we politely make them realize that therapy can be done all day long in the natural environment these children live in?
Now is the time to start thinking positively, about what impacts we are able to make on the children and the orphanage.
Some thoughts on feeding: When the caregivers feed the children in the “laying down" rooms and "sitting up" rooms, they have quite an opportunity to physically touch the children. But they literally dump the food down the kids throats while the kids lay flat on their backs, with no physical contact. I fed a child in one of these rooms today, attempting to do so with him positioned in a semi-reclined position using a wedge under his mattress. Because he is used to being fed on his back, with the food dumped in his mouth, he had a difficult time eating and the process was very slow, as the food kept falling out of his mouth as he struggled to use what few oral motor skills
he has. I doubt he has ever been given the opportunity to feed himself, and because of the spasticity in his arms I imagine it would take quite a bit of therapy to help him learn to do so. He appears to be brain damaged as well, and who knows if he will ever learn to feed himself, or ever need to feed him self. Because it takes SO LONG for him to eat sitting up, I recommended that the caregivers recline him partially to feed him for the first 5-10 minutes of feeding time while he is hungry, then recline him for the rest so he gets the proper nutrition. Each week increase the duration of time he is sitting up for his meal. However, this may be too ambitious of a goal for the amount of time that the caregivers are used to spending feeding the kids, and I start to wonder if it is worth it for his particular case to attempt to progress him to eating sitting up. Maybe the efforts would be better spent progressing another child to eating sitting up. Hopefully the caregivers will generalize the technique to some of the other kids with
more potential.
Those are the thoughts for the day.
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