Shawndelle Pocha reports on her 3 months as a therapist in Malawi!

Hope for the Future

The Children of Blessing Trust is a Malawian NGO which exists to give children with disabilities and their families help and hope for the future.  It does so by offering rehabilitation, education, access to specialized services, as well as acceptance, love, encouragement, advocacy and protection.  It is a Christian organization founded in 2007 after consultations with local traditional leaders and government officials, and its programs run in and around the capital city of Lilongwe.  Individuals with disabilities in Malawi are often the least healthy, educated, employed and integrated in a nation which already struggles with widespread poverty and insufficient educational and health care resources.  Children with disabilities are the marginalized of the marginalized in 

this landlocked country of 15 million people in southeastern Africa.   Through its holistic approach,  Children of Blessing Trust aims to help children and adults with disabilities to redefine the possible and play meaningful roles in their families and communities.   

Rehabilitation services are offered at  the main treatment center in Area 25  in the northwest quadrant of Lilongwe, as well as 5 outreach sites.  Treatment is parent and child centered and aims at maximizing function, independence and quality of life.    In group treatment sessions, caregivers are taught and encouraged to carry out exercises, positioning and other strategies with their kids at home.   Simple braces, positioning pillows, walking frames and other required equipment are loaned out to assist with these home programs, and further support is provided through home visits.   Parent workshops are held regularly to increase understanding of disability, the importance of play, sensory stimulation, activities of daily living, and school, communication, puberty and HIV/AIDS.

At the Area 25 center, there is also an integrated preschool where children with disabilities and able-bodied children are learning together.   Numerous special education programs are also offered.   Nutritional support to undernourished and malnourished children is provided through the nutrition program.  Children and adults with epilepsy receive physician follow-up and medication through the bi-monthly clinics.  Access is also provided to HIV/AIDS testing and counselling, ART, specialized splinting and bracing, prosthetics, orthopedic consultation and surgery, audiology assessment and treatment, and speech therapy.  Through the vocational club, income generating activities are carried out by individuals with disabilities and their caregivers.

The number of clients registered with the program has grown from 45 in the first day of operation to over 1000 currently.  Providing oversight of the programs is director  Kathy Bowler, UBC dual-trained physical and occupational therapist and Pentecostal Assemblies of Canada missionary.  Staff include Malawian rehabilitation technicians, assistants, a preschool teacher and administrator.  The wide breadth of programs and services is made possible through many partnerships with local government, hospitals, schools, health professionals, NGO's and faith-based organizations, as well as overseas churches and charities.   Children of Blessing Trust has hosted volunteer physical and occupational therapists and speech therapists, registered nurses and doctors from around the world, and is a clinical education site for the Rehabilitation Technician School in Blantyre, Malawi.  It has offered one international occupational therapy student placement to date and will host its first 2 PhD of physical therapy students in March of 2013.

One strategy to ensure the sustainability of its many programs has been the formation of a Canadian charity, Thrive Malawi.  It aims to increase awareness in Canada of the work of Children of Blessing Trust and to raise funds to support Children of Blessings' programs for disabled and disadvantaged children.  For more information about Thrive Malawi and the Children of Blessing Trust, as well as stories and pictures, visit thrivemalawi.ca.

A great overview of the programs offered through Children of Blessing Trust will also appear in an upcoming article in the Journal of Physical and Occupational Therapy in Pediatrics entitled: A Model for Providing Comprehensive Pediatric Rehabilitation Services in Malawi.

 Stretching and Support in the Warm Heart of Africa

In the article, “Hope for the Future”, I gave an overview of the Children of Blessing Trust and the wide range of activities undertaken through this ministry in support of children with disabilities and their families in Malawi.  What follows is a more intimate look at the Children of Blessing Trust, made up of a collection of my experiences and impressions gathered during 3 months spent working as a physiotherapist there in 2010.  

Volunteering at the Children of Blessing Trust meant jumping in with both feet and getting swept up in the busyness  of its various programs.  It was a challenging and stimulating experience for me – sometimes overstimulating!  Given the difficulty of stepping in to a new city, a new culture and a new language, it was fantastic to have a group of supportive co-workers who were happy to translate for me and help me to slowly build up a rickety little framework of workable  Chichewa vocabulary.  They were warm and welcoming and let me know that they appreciated having another pair of hands on deck to attend to the many children and tasks.   Many shared generously of their lives, homes and time.

Many of the kids receiving treatment presented with neurological deficits of varying severity, exhibiting cognitive delays, hearing loss, visual deficits, seizures, hypotonia, spasticity, and ataxia.  Causes for the deficits included birth trauma and cerebral malaria.   It was beyond frustrating to see kids suffering with significant disability caused by BUG BITES and other potentially preventable causes.    One girl that I will never forget had been a happy active 5 year old until she suffered a severe case of cerebral malaria that left her contorted with spasms, eyes seemingly vacant.  

My mornings were divided between the main Area 25 center and the sole outreach clinic at the time in Area 49 of Malawi's capital city, Lilongwe.  Some mornings also included consultations with orthopaedic surgeons and castings at the prosthetics and orthotics clinic, while afternoons were a mix of home visits, epilepsy clinics, and time spent hanging out with the babies at the Crisis Nursery.  Treatment happened in a group format, and in my level 2 group, up to 8 kids and their caregivers would work on sitting, standing and walking activities.  Locally-made wooden boxes and donated toys were used, with hands-on assistance provided by the rehabilitation technician, assistant and myself.  Admittedly, numbers of children, noise, heat and stimulation in our treatment room would sometimes increase beyond what is ideal.  Nevertheless, the group therapy format gave moms the chance to learn techniques from staff and from one another that they could later practice at home, and it provided the opportunity to support one another and share ideas.   I wish that I had had more time to talk and pray with moms and kids about their goals and challenges.

Later morning we would move outside to cruise around with locally-made walkers and creep along the covered parallel bars.  Other kids would work on washing, some sitting in adapted buckets to aid with sitting balance in  their respective wash basins.  Hats off to the moms for allowing me, a perfect stranger, to work with their kids after only a perfunctory introduction and request for consent in broken Chichewa.  It was stretching but  fun to try to engage with the kids in functional play and I am more than thankful that so much of communication is non-verbal!   I appreciated how smiles and hugs would bridge the language gap as I tried to connect with these kids and help them to know that they are valued and loved.  I always enjoyed the sparkle in kids' eyes that outshone whatever disability hampered the rest of their body functions.     

During the few home visits I got to do, I was able to see first-hand the distances the moms travelled with their children strapped to their backs.  I enjoyed observing the kids relax and open up on their home turf and I enjoyed the challenge of adapting treatment ideas to their unique environment and circumstances.

A definite highlight of my time with COBT was getting the chance to work with and provide some mentoring to the rehabilitation technician students who were doing their clinical rotations during my time there.  They were professional, compassionate and open to new ideas. 

In conclusion, I would invite any therapist who is looking for a place to volunteer internationally to consider the Children of Blessing Trust in Lilongwe, Malawi.  You will be both stretched and supported as you play useful role in an important  program.