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!