Occupational Therapy Community Services in Arusha, Tanzania
Salome Mushi is an Occupational Therapist at the Faraja Pallotti Centre in Esso Parish, Arusha, Tanzania. Faraja provides free therapy services for 200 children and 75 adults, plus 30 to 40 service users who attend on a weekly basis, including training sessions for parents on handling and facilitation techniques in occupational and physical therapy management. Salome works alongside VMM volunteer, Clare Edwards, who has volunteered at the centre since 2011.
The objectives at Faraja are to dispel the myth and stigma attached to disability, that it is a curse on the parents; to provide therapy and support services to children, adults and the families of those living with a disability; and to treat everyone they serve with dignity and respect.
The Challenges of Providing Disability Services
The majority of service users at Faraja have cerebral palsy and the triumphs of Faraja’s work has been achieved through education and the provision of services in the face of some very difficult challenges. For instance, in the region a stigma persists about disability. Encouraging parents to attend the centre with their children, where they are trained in therapy management which helps them to accept their child’s life-long condition, is one such challenge.
Another is that, many children are locked away in a dark room with no light while their mother has to leave the house to work and provide food for her family. Life is difficult already, and having a child with a disability makes it even harder, especially as there is no state support; and services, if available, require payment that many simply do not have. In addition, although there are more than ten schools in the Arusha area which provide education for children with special needs, none can facilitate the needs of children with severe cerebral palsy, due to the fact that Special Need Assistants are not available.
In light of such challenges, Clare remembers that, “we showed the film ‘My Left Foot’ and the Mamas cried because they did not think Wazungo (white people) had disabled children. They also saw that ‘white Mamas’ had to work hard just like themselves, as they saw Brenda Fricker do in the film. It was an eye-opener for them.” Showing the film helped many mothers accept their child and realize that they were not cursed, but rather that it was a medical problem.
‘Faraja’ Means: Hope, Compassion and Encouragement
Despite these challenges, the staff at the Faraja Pallotti Centre do amazing work and have changed the lives of many individuals and families in the area. For example, Daniel, first arrived aged three, with no independent movement or speech. After three years attending Faraja he is doing very well. With much hard work by his mother, who carried out his home therapy programme, he began to walk independently, started communicating and now attends school. Indeed, many other Faraja service users have similarly been assisted to become independent and reach their full potential through attending school and securing employment.
Another success story is that of Loitajeu, a twenty-two-year-old man born with clubbed feet and unable to walk upright. Due to the stigma, his mother hid his condition from their family and neighbours. After much hard work with the team at Faraja, surgeons agreed to perform surgery and six months later Loitajeu returned to his village walking upright with crutches. He continues to attend Faraja every three months for further therapy.
Salome’s Visit to Disability Services in Ireland
In April, Salome flew to Ireland with Clare on a whistle-stop tour of health centres and schools providing services for people living with disability. First she visited the Royal Hospital Donnybrook and the Enable Ireland Centre in Dublin, before moving down to Clare’s home county of Kerry, where she visited Kerry Intervention Disability Services, in Tralee, and St. Oliver’s National School and Cahernane Medical Centre, in Killarney.
During her visit to Ireland, she found it to be green and well-organised and liked the country and the people very much. Some of the takeaways that Salome noted on her tour included the trans-disciplinary care offered to each service user and the emphasis on their ‘ability’. She also noted the teamwork between these varied medical disciplines, also incorporating the family’s input through questionnaires during the assessment and intervention processes, and the rigor of their record-keeping, with all details being kept in each service user’s file. Even little things like, using a sticker in the file to note when a service user had been seen by each specialist, or the numbering and recording of equipment in this file when allocated to a service user, were valuable little observations.
Another of Salome’s observations was the adaptation and variety of amenities, equipment and toys for the service user’s support and comfort, which thus nurture their independence and progress in engaging with their therapy programme. So too, how, before being discharged, a home visit is conducted to assess the service user’s needs while at home; and also, that their discharge assessment report is forwarded to their doctor or local medical centre.
At St. Oliver’s, fully wheelchair-accessible, National School, which provides special needs classes to children with different disabilities, Salome noted the level at which both teacher and parent are involved in therapy management. There is also a heightened awareness about disability among the student body, which greatly reduces any stigma attached to those students with a disability. In the school, procedures, checks and balances are in place to ensure the protection and dignity of all students through the implementation of a child protection policy.
What Lessons Were Learned and Shared
Salome enjoyed her time in Ireland, learning from and sharing with her fellow care professionals, all of whom share the dedication to serve and empower the most vulnerable members in our communities.
From her observations she intends to implement some measures to adapt the procedures and policies and broaden the facilities at Faraja to further improve the experience for their service users. She plans to start a family member group and new initiatives to increase disability awareness in the wider community; to encourage better cooperation with special needs schools in the area to improve access to education for children with disability; and to seek access to a paediatrician to improve diagnosis and help Faraja staff to better understand the medical conditions of the children they work with.
Salome is determined and ambitious and a passionate advocate for all the children and adults living with disability who attend Faraja. Among her long term goals for the Faraja Pallotti Centre, she intends to work in collaboration with other teams from different medical centres and hospitals to set up a simple sensory room and to provide access to a speech therapist, a social worker and a psychologist.