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!

Trust

I am not a great writer. Or a great thinker. Maybe not a great "anything." But I'm good at a few things. Baking. Taking care of my kids. I even think I'm a pretty good Occupational Therapist. But I'm not very good at change. And I get frustrated very easily when things don't go like I think they should (which, of course, changes never happen when and how we think they should...).
Well, big changes are happening for me in 2014. In case you haven't heard yet, I am leaving the clinic to pursue a teaching career. Starting January 6, I will be an Assistant Professor of Occupational Therapy at the University of Indianapolis. (Read my last post about feeling like I'm jumping off a cliff... that was 3 days after my interview). This has all come up rather unexpectedly, by invitation, and about 2 years sooner than I thought it would happen. But it is something I have been working toward, thinking about, and yes, praying for, for a number of years now.
So, the one word I have chosen for 2014 is TRUST. I have not been a great "truster" in the past three years. I have been a bit off-balance in my faith walk ever since taking the job at Balance Point (pardon the pun). But God has been ever working, behind the scenes, to make me into the person he needs me to be.
So I am trusting. I am re-learning how to be a person of faith. I am hopeful, and grateful, and looking forward to the future. And that is a better place than I have been in for a long time.

Transitions

Whew! I somehow got locked out of my blog for about 6 weeks. No idea how. But I think maybe it was for the best, as I have been far, far too busy to think about posting anything. Pretty much, I have been far, far too busy to think in general. Life has been moving pretty fast. I completed the grad school assignments finishing my 7th out of 15 course requirements on my journey from my Masters degree to my clinical Doctorate degree. As part of that, I had two presentations, one to a community group and one to occupational therapists at the state conference. I have also been confronted with a number of situations convincing me that life just keeps going forward, and you can't go back. With all the craziness of the last 3 years, I have been contemplating how to reclaim who I am - retain the essence of who I was intended to be, hang on to a shred of my faith, stay true to the things I want to be and do... all while continuing to grow, and stretch, and live life with joy as I continue to become the person God intended me to be. I am about to become an empty nester again, as our daughter is about to move out; and I can see the winds of change in my career, and it looks less like a transition and more like a jump off a cliff, hoping there's a safety net or a deep pool of water or SOMETHING to catch me.
I took a walk about a week ago, at sunset, and it was pretty incredible the way a fall evening spoke to my soul. The moon through the bare trees and the colors of the sunset over the fall leaves left me feeling speechless and remembering that everything happens for a reason. And things happen in the right timing, even if it is not the timing I was expecting or that I would prefer. And, despite all the evil in the world and the seemingly pointless and meaningless and PAINFUL things that happen, beautiful things keep happening too. Hope keeps coming through in the most unexpected places. Like, between bare trees and through darkening skies. In patients you thought would never get better or journeys you thought would never come to an end. Like, situations that sucked all the joy out of your life suddenly being revealed for the catalyst it is that makes you get off your rear and do something different, that you never would have done, if it hadn't been for the joy-sucking experience pushing you. I know I'm being cryptic; I can't tell all, but hopefully I will be able to soon. Maybe you are stuck in a joy-less place right now. My prayer for you is that you will be able to trust and have faith, find joy where you are, and that soon you will see some transitions starting to occur, like blades of grass springing through concrete, or a beautiful moon shining through bare trees, and know that there is a reason. There is a reason. There is a reason.

Simple Living and a Cat

Ginger in her Happy Place

My son has been reminding me of how far we have gotten from our simple Christian living roots. Namely, we  recently paid to have our windows washed and to have our dead trees taken down. These are things we might have done ourselves in younger days (and when living in places where the trees and windows weren't scarily high). We still tend to be do-it-yourselfers for most maintenance, but we also are a little more willing to hire things done. It often becomes a matter of choosing between the economics of money and the economics of time. Hence, the struggling with our desire to be simple living Christians and our need to stay sane in our fast-paced world of careers and activities.

But it was our 16-year-old kitty Ginger who this week has highlighted for me the complexities of the choices we make, how (more often than not) the lines get blurred, and that our choices are rarely as clear as black-and-white. It was not her ability to relax or play when there is work to do, or to enjoy bacon although she is already portly. Though, those aspects of her personality do remind me to stop and smell the roses from time to time. Instead, it is that she is currently deathly ill and spending her second night at the vet's office in hopes of reviving her a bit to bring her home and enjoy a little more time with her. And the question of the week is, when do you stop paying to save a life? The economics of the value of the life of a cat are glaring me in the face right now. On the one hand, I love her dearly and am missing so much her begging round my feet while I fix dinner or rubbing on my ankles while I comb my hair in the morning. On the other hand, she is suffering greatly and in pain with pancreatitis, and antibiotics and IV fluids and meds have failed to improve her situation in the last 24 hours, though she at least is not worsening. And while I have shed tears over her rapid demise, I also have wondered: how much is this costing me? And how much more am I willing to spend?

Sadly, though I am asking (and have the luxury to ask) this question about a cat, many folks have to ask this question about their health care. And I'm talking about right here, with my own patients. I will often finish an evaluation and recommend a treatment plan, only to have the patient ask, how many times do I have to come back? how much will it cost me? can we stretch it out a bit or can I come less often and still get some benefit out of it? Because they are counting the dollars of their co-pay versus getting groceries or paying for gas for the week, and wondering if their last paycheck will come and if it will be enough, and when they can feel well enough to get back to work and get another paycheck. So the economics of life often get in the way of our altruistic ideas of what we would like to do to save a life, return a person to function, improve the quality of life, etc. How hard must it be for those who have to make economic decisions about the health care of a loved one? Just some more musings that are all mixed up in my contemplation tonight. Sigh.

I am having a hard time deciding what to do about my kitty - after all, I firmly believe that if you take a pet you are committed to them through thick and thin for life. I don't want to ditch on her. Nor do I want her to suffer. Nor do I want a $3000 vet bill. I don't know what the answer is. But I keep struggling forward. I want to be a simple living Christian, a good wife and mom, and a good pet owner. And I do try to make these decisions remembering grace, mercy, and love as the first rule. Just as I most assuredly need the grace and mercy of a loving God tonight.