OT in Malawi

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Occupational therapy isn’t about finding people jobs, but about helping people participate in anything that is meaningful to them. It fits into a variety of settings and looks different from place to place and person to person.
Malawi isn’t the “Africa” picture often painted in the West full of poor people living in huts. Yes there is great poverty, but there is also great wealth. There are homes that are huts and those that are accompanied by guest houses for visitors. Malawi is a diverse country where life looks different from place to place and person to person.
With such a variety within OT and Malawi, the mix—OT in Malawi—is just as much of a diverse experience. I can’t cover it all or really even come close but I can attest to the pieces I have seen.

It’s in a pediatric private practice where kids are treated in a clinic, as well as in private and public schools.

It’s in a government hospital and an inpatient rehabilitation center.

It’s financed by the profit of the organization, by the government, and by outside sources of aide.

It’s working alongside physiotherapists, speech therapists, learning support and rehabilitation technicians.

It’s an OT volunteering time in a village on a day off and another whose job is
building capacity for long term development.

It’s in a group of children who aren’t able to go to school, gathering for “their school.”

It’s in a group of men gathered to practice using their affected arms post-stroke.

It’s in a hospital where the needs are far more than the resources, but nevertheless needs are being met.

It’s one on one sessions in the clinic, one on 20 in a school, and one on many more in the hospital.

It’s provided to children with autism, down syndrome, cerebral palsy, and ADHD.

It’s games rigged for a win to build self-esteem and those rigged to be lost to practice social skills.

It’s chalk on the trampoline, paint on the wall, and handwriting in play-doh.

It’s vocational training to someone with a disability to give them an occupation and a livelihood.

It’s songs and games and crafts targeting joint engagement, auditory memory, attention, fine motor skills, and social participation.

It’s a pretend “lion hunt” through a jungle of tunnels and ball pits, and it’s parent education to provide strategies for home.

It’s adaptive equipment given to a mother who has walked two hours for a short treatment session.

It’s handwriting practice and a game of UNO played with a child dropped off by their driver.

It’s a group of therapists determined to develop the profession within the country, to start a program, and to meet the needs of the people.

It’s 9 therapists, both Malawians and expatriates, to 1.5 million people.

It’s a resilient profession that is growing and developing to help Malawians be all that they can and live the most meaningful lives possible.

It’s all of this and more. And it’s been a pleasure to be a part of it.
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One need was met

Often when working with people with disabilities, you work and work and slowly see progress. Change is not usually instantaneous. But today it was. And today I was reminded of the extreme power of occupation to radically change lives.

Today we went to a village with DIDP, a volunteer organization run by one director of Sandi on the weekends, where we saw clients from the area. I share with you one story among many:

After walking probably two hours to see us, a mom entered and laid her six year old daughter on the mats in front of us—a precious little girl with cerebral palsy that neither engaged nor participated in daily life. She spent her days laying on the ground outside their house fully dependent on others. Initially we were concerned not only about contracture and atrophy of muscles, but also cognitive involvement based on her lack of interaction with us. However, we grabbed a corner chair to try to improve positioning and we were blown away. Immediately we were taken back by the core strength she exhibited and delighted by the bright eyes and smile that now lit up both her and her mother’s face. She began to engage with us and as we added the lap tray and placed toys, we were easily able to engage her in purposeful activities, joint engagement, modeling, and pretend play! When we gave her a spoon she began to pretend to feed herself. Her mother had never even seen her really use her hands let alone do so purposefully.

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That chair offered hope. It offered a whole new identity to a child whose life had previously been riding on her mother’s back or staring at the sky. She no longer has a poor forecast of a future, but can engage with peers and participate in daily life, learning from those around her. We gave her the chair and drove her home at the end of the day.

Today the gift of a chair costing not even fifteen US dollars completely changed the world of a little girl in a village in Malawi. It won’t always be so simple or so radical a change, but in the rural areas where the needs are great and the care is distant, simple things have significant impact. There are lots of kids like this little girl—lots that would benefit from chairs or equipment. Lots that have needs that continue to go unmet and potential unreached. But today, one need was met that changed many lives.


The Single Story

There are things I could share about my time in Malawi that would make it sound like vacation.

There are others that would make it sound challenging and refining.

Still there are others that would make it sound quite similar to life in the US.

Truly it is all of these.

Something my current supervisor has challenged us to consider is the power of the single story. Often we create an entire perspective of a culture, experience, or person based on a single story. But there are many stories. There are many aspects.

As I write I share a piece of my story here and of OT in Malawi, of my life as an expat, an OT student, and a Christian in Malawi, here for a few weeks in a few places. But it is only a few pieces and even then only a few of my single story.

I wish I could better share about Malawi and life here beyond my story to paint a more accurate picture. I wish I knew more of Malawi to have a more accurate picture. It is an incredible place with both beauty and challenges and challenges that reveal beauty. It is a place that has great need and great things to offer. There is much to learn from and of Malawi.


Sleeping with Elephants

Last weekend we went on Safari at Liawonde National Park.

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Saturday we did a game drive with high hopes of seeing elephants. Though we had a lovely time seeing all kinds of animals and enjoying the African sunset and pleasant drive on the Safari vehicle, we saw no elephants.

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Disappointed we decided to book the boat safari for the next morning.

However, as we slept in our tent that night we heard loud footsteps all around us. Slightly concerned about the hippos that were probably roaming just outside our tent we didn’t move.

IMG_2922It wasn’t until the next morning that we were told that not only were there hippos (and of course warthogs and monkeys) near us, but the elephants had come through as well!

Our boat safari was pleasant and we enjoyed seeing heaps of hippos and crocodiles much larger than I could have imagined. And just five minutes before time to return what did we see, but a whole family of ELEPHANTS!

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Ndironde: play is universal

 

Tuesday afternoon we finished up at Ndironde, an outreach to families of children with disabilities. There, we were tasked with developing a program providing occupational therapy to be implemented after we leave.

This is one of the things I love doing. But it is challenging.

Last week I was disheartened by the language barrier and our inability to facilitate the groups we had come up with due to our limited vocabulary. The program will be implemented by someone who speaks Chichewa, but still we had to try out activity ideas and go through the trial and error process.

To be honest, I wasn’t excited about going this week.

In the back of my mind I know that even though language may be a barrier, play is universal. But… last week though, our play skills were lacking the ability to lead a group more than 10 minutes or so… with a Malawian therapist leading the other group. Thus, I was not looking forward to just the two of us going to lead our newly developed groups today.

Let me return to the prior statement:

even though language may be a barrier, play is universal.

And with a few more Chichewa words in our vocabulary, it was highly effective.

The kids engaged, the mothers participated, and we all had fun. We promoted social participation, play skills, turn taking, and modeling. The mothers and children demonstrated joint engagement and the activities promoted development of gross motor skills. We adapted our plans accordingly and presented it to the Sandi staff this morning for feedback.


A short update

The election results were finally released Friday, the new President was inaugurated Saturday and celebration ensued today. With that behind us and school back in session, the pace is picking up again at Sandi-Blantyre as we head into our last week here.

In the meantime, we have been busy working on projects and presentations and enjoying our time here. I presented on how sensory processing patterns can inform treatment and Shannon presented on ADHD. We have also worked on diagnosis brochures for the clinic and developing a community based program to be presented later this week and implemented in the weeks to come. We visited the gorgeous Satemwa Tea Estates for tea and cake, went out in Blantyre for music, visited the Blantyre market and ordered clothes made of local fabric from the tailor.

In the midst of learning and being tourists, we have so deeply enjoyed the people we have come to know here in Blantyre. The therapists we work with have been incredible at showing us around and including us in their lives. It has been a blast to become friends with them and even get to celebrate our CI at a wedding shower this last weekend. The community here is great and it is definitely one that we will miss as we move up to Lilongwe next weekend. However, we are excited for the adventures we will find there and to hang out with friends from there we have already made!

I am horrible at taking pictures, but promise to have some soon especially since we will be camping and heading on Safari this weekend.


Perspective.

With the elections last week and kids on half-term this week, it has been a little slow in the clinic here. Nevertheless, I am learning a lot and am grateful for the extra time for research, reading, and professional development. We have now had the opportunity to visit one of the public hospitals, Queens, and  rehabilitation centers Malawi Against Physical Disabilities (MAP). There is an OT at each location. Visiting these places is both encouraging in the work that is being done and eye opening. It provides perspective.

Both facilities are great facilities and the OT’s are doing incredible work. Challenging work. Life-giving work.

At each there is 1 OT. That’s 1 for the whole hospital (one of the few with an OT) and 1 for the rehabilitation center (MAP).

Malawi has a population of almost 16 million people.

There are 9 occupational therapists.

That is 1 OT to more than 1.5 million people.

In the US there is need for growth within our profession, but in the US there is somewhere around 1 OT for every 3 or 4 thousand people.

The perspective shifts. However, a bunch of expatriates coming to Malawi isn’t the solution. It won’t meet all the needs. Malawi needs development and programs so that it can produce therapists, a work that is in the process. As we walked through Queens, we saw the enormity of the need. In some ways it was odd knowing that we are a private pay clinic and have limited time for outreach. However, this clinic is an important part of development here. It is Malawian run and is self-sustaining. It is ground-breaking. Later this week we will gather with the other occupational therapists in Malawi for an Occupational Therapy Association of Malawi (OTAM) meeting. I am looking forward to hearing more about the profession as it develops here in Malawi.