Magical Moments (Or, my last post about Belize, I promise!)

Our Belize Team!

The laundry is done, the suitcases are wiped down and put away, and the mail pile has been conquered. However, the trip to Belize is still fresh in my mind, and I wanted to write down a few parting thoughts.

The Belize experience has been an incredible journey of learning and humility. The fall prevention program I designed helped start me on a good path toward offering a useful service, but what I found I need to do in order to provide OT in a cross-cultural setting is listen, listen, listen. The people will tell me what they need, and they did. They also were gracious in forgiving me for my mistakes and appreciating just some simple attention to their needs. So many good things happened, and not just with my work team. As I mentioned in my first post about Belize, I was with a group of 25 individuals who provided PT and OT service to people in Belize. Some were poor, others were not. All were in need of rehabilitation in a country that is sorely lacking in PT and OT services. Our teams included pediatric school care with NaRCIE; pediatric outpatient and home-based care with the Inspiration Center (both NaRCIE and Inspiration Center are services provided by donations and work with children with special needs); work with older adults in two residential facilities, Octavia Waight Centre and Sister Cecelia’s,  operated by HelpAge (we would call them nursing homes); the fall prevention program with HelpAge’s adult day centres (more like senior centers than adult day care); and the home care team who visited home-bound older adults who are cared for by HelpAge aids. Here are some of the special memories and moments that occurred during the two weeks we were there.

·         A PT and OT student worked together to wash and bandage the foot of a homeless man who had an open wound, and had only the river in which to bathe. The man wanted to know why bad things had happened to him, and if God cared. The student told him, “I don’t know, but I can wash your foot and make it feel better.”

·         A team of OTs, PTs, and students worked together to get a woman in a residential facility out of a broken wheelchair and into a new one which they found in storage. The woman went from being hunched forward and unable to lift her head, to making eye contact, laughing, and engaging in activity.

·         A student helped a man learn how to work with his severely disabled son. Later, the student found the man sitting in a chair with his son and rocking him and talking to him. The student said, “I can tell he is your buddy.” The man said, “I don’t know what I’d do without him and I wouldn’t trade him for anything.” This man had so little materially, but the student felt this child was in just the right place to get everything he needed from this caring father.

·         Adjusting a walker helped a woman go from walking nearly doubled over, to standing up tall and using her walker correctly. This greatly increased her safety when walking.

You get the idea. Over and over, the students saw how small things – just little interventions – could make a big difference in someone’s lives. They gained respect for the people they served, and respect for their own profession. What’s more, they learned to work (and play, and laugh) with each other as an interdisciplinary team of PTs and OTs. I watched the two groups go from being divided along discipline lines at the beginning of the two weeks, to asking, why don’t we get together more often? They became clinicians and colleagues who could look past disciplinary boundary lines and appreciate each other for what each one had to offer, both personally and professionally. People coming together. Lives being changed. It doesn't get any better.

I must admit, the last four years have been a difficult journey for me, and I very nearly lost my way. I almost forgot who I was and what is important to me. This trip has taken me back to my roots, and at the same time propelled me forward, not just in my career and degree pursuit, but in an understanding of myself, who I am, and what I need to be doing. I have been reminded to not let the world around me squeeze me until I am unrecognizable, but to continue to seek transformation as I continue to become the person I was intended to be. Sound like something you might have read before? Romans 12:2.

Happy travels to you and yours on this journey of life.

Success!

Our fall prevention research team in Belize has had an incredible couple of days in Belize City, and we were able to double the number of participants in our study from 9 to 18! This is thanks in large part to the efforts of Mrs. Bulwer, the national director of HelpAge Belize. She saw that very few of the persons who came to the fall prevention class in Belmopan were appropriate, and she took it upon herself to make sure that people were planning on coming here in Belize City and were appropriate for participating in the program. She also called the media, and as a result, she and I were interviewed on local TV. While watching myself on TV is AWFUL, I must say I didn’t make a total idiot of myself and managed to express what we are attempting to do with the fall prevention study. We had a good, albeit long, day with the folks at the HelpAge Centre yesterday, and completed both testing and the class portion of the fall prevention program. Some of the obstacles we encountered were the oppressive HEAT, the cultural need to feed the people when noon rolled around (even though I provided a snack at 11:00 am), and the resultant somnolent state of the participants after lunch when I was trying to teach. Anyway, we got through it, and today’s results show people retained at least some of the information!

"Scrubs"

Today, we completed home visits in two teams with the nine participants. Although it was a long hot day, it was a really good day of spending more personal time with each participant. I heard many stories, some related in Creole. One of my favorite memories of the day was trading Creole and US sayings – things like, “least said, soonest mended” and “fool me once, shame on you, fool me twice, shame on me.” There’s a Creole version of that one but I can’t remember it! We were in the city today, so all homes had indoor plumbing and other modern conveniences, although some of them were quite small. Most people have been in their homes 40 years or more, and have great resources in their neighbors. The houses are just a couple of feet apart in places, and when I asked one woman what she does when  she needs help, she said, “I just yell real loud and my neighbor next door hears me and comes to help me.” The neighbor also watches the front gate and shoos away anyone who comes who doesn’t belong there! I wish people in the US were that caring about their neighbors. What Belize lacks in physical resources, it makes up for in human resources. There is something to be appreciated about such a communal and caring culture. Families are so tight-knit, and people just look out for each other. Everybody knows everybody else, and no one ever met a stranger. People even answer questions communally, which is a bit of a problem when it comes to data collection! I am sorting it out, though.

This has been such a fascinating experience. It has been challenging in ways I did not expect, but also some things were easier than I thought they would be. I have a lot of data sorting to do when home, but I have completed what I set out to do! We have one more full day here, which will be spent in some organization and entry of the data, and then we leave for home on Saturday morning! Thank-you to everyone for your support! 

Getting there is half the fun!

Friday was a work day in the morning and a travel day in the afternoon. In the morning I got to complete data entry for the demographics and other quantitative data, and worked on some qualitative notes as well. Some themes are already arising. The first is that everything relates to a relationship; participants will tell me a story about their neighbors instead of answering the question. (Question: Do you think having a stroke can make people fall? Answer: My neighbor had a stroke and they had to quit work and their daughter had to quit work and take care of them and it was sad.) Also, people see worrying as a character flaw and therefore no one will say they are worried or fearful of falling. Because of such responses, I may not get to use the quantitative data, but I am still collecting it at this point. It’s a good learning exercise for me even if not useable for the research. But qualitatively, I think I will have some really interesting results and insights both for fall prevention in a developing country, and cross-cultural challenges.

"Sleeping Giant" - can you see the nose?
He also has feet! This is a well-known
landmark in Belize and is on some of
the currency here.

Traveling for the 2 hour bus ride to the coast on Friday was really fantastic. We got to see the beautiful mountains between where we were inland and the coast, and even some well-known natural landmarks. I now see what they mean when they say this country is sparsely populated. We passed some citrus production factories (I now know where our orange juice concentrate comes from!) and many orange groves. Surprisingly, very little coffee is grown here, and not in the areas where we have been. We arrived at Hopkins, a sleepy coastal town, where we are spending the weekend getting some R&R and planning for next week. We happened to come on Hopkins Day, the only time of the year this village really comes alive. The people here are Garifuna, a mix of African slaves dropped off on the coast in the late 1700’s, and the indigenous people. They retain the indigenous language. The music I have heard can only be described as reggae-rap, and the singers call out to the crowd in both English and Garifuna. I am enjoying beach life! The food is great, and the place we are staying is magnificent. I walk out my door and am on the beach. Yep, it’s the life.

We will leave Tuesday for Belize City, which is the old capitol and the most densely populated city of Belize. We will spend our last week there in PT/OT service provision and finishing my research work. I will probably post at least one more time from there. Thank-you for following my posts – it is encouraging to know that so many friends and family are thinking of me! 

Rising to the challenge of the moment

UIndy OT Fall Prevention Team

Well, here is the team picture I finally got to upload! This was yesterday, Tuesday 7/29/14 in Belmopan, Belize. That was a very challenging day. We dealt with language barriers and misunderstanding (ignoring?) of my inclusion criteria, to the point that I almost didn't have any participants. We ended up having a great day of fall prevention testing and teaching, translated into both Spanish and Ketchi (a Mayan dialect). The students truly rose to the challenge and learned to give instructions to people who couldn't understand a word they were saying, through demonstration and pantomime, and use of whoever was willing to translate. They totally got the job done! While I can't use non-English speakers in the research, I truly hope the participants got something out of the day, and I think they did. The students seemed to. We learned a lot about cultural appropriateness, too. It is inappropriate to send people home empty-handed. Fortunately, HelpAge provided biscuits and juice (a typical mid-day snack) for people to eat before they left for home. Everyone seemed to have a good time.

Today we completed our first full day of home visits. Though Latin American homes were familiar to me, I think they were a bit of an eye opener for some of the students. There were some homes that were truly beautiful and functional, and some that lacked what we would consider basic necessities, especially for older adults. How do you complete home modifications for an outhouse? Or, had you ever considered the fall risk that free-range chickens and turkeys in the yard would present? I also learned that when you grow up in a society with limited health care, you learn a limited health vocabulary. For example, what if you have never heard of tranquilizers? Or used a Likert scale to express how you think about something? I was feeling really challenged about the data I was trying to collect, until my husband (a sociologist) reminded me that part of what I am doing is studying the difficulties of researching in a developing country. Although I plan to continue to attempt to collect fall prevention data, the heart of my study may end up being a report on some of these difficulties.

Tomorrow will be another day of home visits - wish us well! 

Lots of fun, a little work

I have about 15 minutes for a quick post, so I will get down a few thoughts quickly! If you have traveled with a tour, you know things are scheduled very tightly and you get very little alone time. It has been busy thus far, but a lot of fun! We arrived on Friday 7/25 without incident, and after some fun time at the zoo and a long drive, we arrived in San Ignacio, Belize, at the foot of the Maya mountains, or so they tell me. It's very hilly, more like the foothills of the Smokies than what we typically think of as mountains. We went to the market and climbed a pyramid with a view into Guatemala just 9 miles away on Saturday. On Sunday, we went zip lining on a 12-line course that stretched through the jungle canopy, and the last one took you on an elevator above the canopy for the most amazing view! The elevator was the scariest part. Once you see how safely they clip you on, it's not scary at all. Well, not much.
My work with the fall prevention research started yesterday, and I encountered some challenges, some anticipated, some not. The promised set-up before we arrived didn't happen, and we had to scramble to make the area ready. This was complicated by the fact that we were working in a gazebo, and we had had torrential rain the night before (as we have been having every night). So, mopping had to happen, which Candy did for us. When the people arrived, I found I had issues of non-English speakers, illiteracy, and dementia to contend with. But out of the 9 people who came, 6 qualified for the study. I let everyone take part though. I found some people easily caught on to what I was trying to teach, while others really struggled. Even having lots of pictures didn't help much. I also found some interesting views on medicine. Two answers to the question of how to prevent falls were, bush medicine, and prayer! While I believe in prayer and some use of alternative medicine, they aren't really what I had in mind!
We also completed a home visit and got a good feel for how the home visits are going to go.
It was an exhausting but good day! Today we will go to Belmopan (about an hour away) and do it all over again!
PS - internet is slow here and I'm having a hard time uploading pictures to the blog. I will try again later!

Traveling again

Belize, Central America

Belize Market

Mennonites in Belize

My UIndy "Official" Photo

 It's hard to believe, but the time is almost here for me to travel to Belize to complete my research for my Juried Project! For the past two years, I have been working toward, planning, developing, and yes, praying for, this event. In one week, I will be traveling to Belize with a group of 25 entry level PT and OT students, faculty, alumni, and post-professional students for a cross-cultural learning experience. I actually have three roles on this trip: I am supervising the fieldwork of two OT entry-level students, I am completing the Post-Professional Seminar in International Practice course (a mix of cultural competency and experiential learning) and, most importantly, I am conducting Fall Prevention research in partnership with HelpAge Belize, a private, non-profit agency that works in several countries around the world to assist older adults in achieving and maintaining independence, and works with Belize's Ministry of Health for that purpose. Toucan Educational Programs is our on-the-ground support service to keep us organized, traveling in the right direction, and not committing too many cultural gaffes. I could not do this without TEP and Rhondine, their capable Director.

Selfie with Candy at AOTA Conference

What will I be doing while there, you might ask? I have developed a fall prevention program based on the best evidence available in the literature, condensed into a two-session format and written with health literacy and cultural relevance in mind. I, my advisor Candy, and four OT students will conduct fall prevention classes, and then, on the second day of the intervention, visit the homes of the participants to conduct home hazard assessments (The rest of the group will be working in other clinical locations). For the research, I am using a questionnaire before and after intervention to measure the increase in awareness of fall risks. We are also completing a fall risk screen (questionnaire on fear of falling and three balance tests - standing, walking, and sit-to-stand endurance) prior to the class, and a brief interview after the home visit. We will be doing this in three locations (Belmopan/San Ignacio, Hopkins, and Belize City) throughout the country. When I come home, I will compile both quantitative and qualitative data into a nifty Juried Project, similar to a dissertation, and hopefully will be able to invite you all to my defense/presentation of said project by December (and the party afterward!).
Mostly, though, I really hope to be able to help the older adults of Belize. The country is a mix of over a dozen cultures, including Maya, Mestizo, Garifuna, and Mennonite (yep!), with English as the primary language and multiple languages and dialects spoken by the 330,000 inhabitants spread sparsely over a small area that includes Caribbean coast, mountains, and jungle. Health care, by American standards, is very limited. Those who can afford to, seek medical assistance in Mexico or Florida. Those who can't, make do with the limited government hospitals and clinics. I found very little research looking at the plight of older adults in the region, and even less on what is being done about it. Untreated chronic conditions abound.

El Salvador, 2008

I have had a longstanding interest in Central American needs, dating back to my first trip there in 1997. I am so very excited to begin this project, and what I hope will be a continuing relationship to improve health care in at least some small ways for this and other under-served populations. I leave July 25, and return August 9. I hope to use this space to journal my personal experiences, and I hope you'll come along (virtually!) with me!