Medicine & Healthcare, Occupational Therapy in Cambodia by Amy Honeysett
After working as an Occupational Therapist in London for five years I was ready for a change of scenery, so after some hard-core saving I put my flat up for rent and set off to work in New Zealand, with the aim of travelling for six or seven months along the way. It had never crossed my mind to volunteer, but as soon as I entered Cambodia I fell in love with the country and the idea flitted through my mind that I could put my OT skills to good use there. After a few weeks of moseying around Vietnam my mind was made up, and I signed up to start volunteering two weeks later.
My options were pretty limited at such short notice but I found Projects Abroad offered a few short-term OT projects in Phnom Penh, available to start as soon as I could get the paperwork sorted. I spoke to a project advisor called David who told me a care home called Home of Hope needed therapy input the most. There wasn't a huge amount of information available about the placement (compared to the more established programme at the Veterans Centre) but I decided to follow his advice and go for it. My budget only stretched to seven weeks of volunteering and after a flurry of paperwork I arrived in Phnom Penh ready to get going!
My Accommodation and life in Cambodia
I arrived in September, which is apparently known for being one of the quietest months volunteer-wise. There were initially seven of us living across two large apartments; however, as the weeks went by more and more volunteers arrived until there were a good 25 or so of us spread across four conjoining apartments. Everyone got along great and there was always something to do: chilled out nights on the roof terrace, weekend trips away, trips to the ice cream parlour or nail salon or gym... and don't forget everyone's favourite Lebanese restaurant (Beirut Cafe) on the river front. Socially, we had a blast and it kind of felt like being back at university again.
My Occupational Therapy placement
I didn't know a huge amount about Home of Hope before I arrived. All I knew was it was a care home for disabled male adults and children, as well as for those affected by HIV, and was run by the Missionaries of Charity, following the teachings of Mother Teresa. I also knew that they were in desperate need of a therapy service. It turns out that the care home was initially set up for men with HIV but also opened their doors to boys with learning disabilities and/or physical disabilities back in 2007. On my arrival there were thirteen boys, ranging in age from 7 to 23, none of whom had ever really received therapy before.
In 2014, Projects Abroad made a long-term commitment to improving the quality of life for the residents at Home of Hope, and in July a volunteer group converted a disused room into a physiotherapy room. Since then, a few therapists had come and gone, but left little trace of their work, meaning there was no continuity between therapists.
I had two main roles at Home of Hope. Firstly, to set up a long-term therapy programme that could be picked up and continued on by each therapy volunteer in turn. Secondly, to turn a disused room into a multi-sensory room, this would be beneficial for several of the boys with more profound learning disabilities.
I should note at this point that my speciality is in adult brain injury services and that I had absolutely no experience in paediatrics whatsoever! However, what I did have was a network of paediatric OT and physiotherapy colleagues back home, who were more than willing to give me advice when I needed it (which was a lot!).
Home of Hope is run by four priests from India, alongside several local care staff. At the time I started there was one other volunteer – a care worker – who quickly became my rehab assistant. With no formal supervision, the freedom to do as we pleased, and very few resources, we had to use all our creative and organisational skills to make sure we were working as productively as possible.
While the staff at Home of Hope obviously doted on the children (who were a very happy and energetic bunch despite their circumstances), they did not understand the importance of stimulation for a child's development and quality of life, and the children were left to play by themselves with no organised activities and few toys. Several of the boys also had physical conditions that had progressed further than they ever would back home, due to the lack of a formal diagnosis and therapy input. I definitely had my work cut out!
Volunteering at Home of Hope
My first project – setting up a long-term therapy programme – involved creating an assessment/treatment file for each of the boys. This was harder than it seemed bearing in mind they had no diagnosis or even date of birth. It took nearly three weeks before the boys each had individual treatment plans and goals to work towards. The therapy input required was a generic mix of OT, physiotherapy and even speech and language therapy, so I really did have to rely on support from my colleagues back home to assist me with developing treatment plans.
The project also involved creating a comprehensive induction folder so that even a therapy student would have the confidence to pick up and continue on with the programme. My aim was that care volunteers would also be able to get involved with therapy goals too.
My second project – setting up a multi-sensory room – was a slightly larger challenge. I began with researching existing sensory rooms, and then moved on to compiling a list of resources required specifically with the boys at Home of Hope in mind. As much as possible this included DIY materials that could be made in a volunteer workshop. This then had to go through the Projects Abroad budget team, and while the project was escalated and prioritised as much as possible, by the time I left, although the resources had been agreed on, they had not yet arrived.
Luckily, another OT (who was working on a different project) agreed to step in and finish setting up the sensory room and individual therapy programmes once the resources arrived. In the meantime I drew up provisional sensory programmes for the boys, which could be adapted once they had been trialled.
My Experience as an Occupational Therapist in Cambodia
There were highs and lows. The highs involved seeing how much the boys were benefiting from therapeutic intervention. To give a few examples:
One seven year old visually-impaired boy bottom-shuffled his way around and was completely uninterested in exploring his surroundings (he often lay face-first on the ground for hours at a time). By the end of the seven weeks he was able (with encouragement) to walk a few metres with supervision, feed himself (if the spoon was loaded for him) and had gained some interest in exploring items positioned nearby with his hands. He has a huge potential to continue developing his independence if the therapy programme is continued.
Another twelve-year old boy had spent the last year or so lying on the ground due to a stiff and deformed spine (and poor disability management) which had led to significant physical complications. He was initially extremely reluctant to engage in any form of physical therapy but by the end of the seven weeks he was able to sit up in an adapted wheelchair for up to 90 minutes at a time, with close supervision. Again, he has a huge potential to continue improving with on-going therapy.
The main low was that Projects Abroad have had difficulty recruiting therapists or care volunteers for this placement. At the time I leave (one week from now) there are no volunteers formally lined up to continue the project, although a few fellow volunteers have offered to spend a few half days a week helping out. I am actually writing this piece in the hope it will attract future volunteers to Home of Hope.
It is such a worthwhile project with so much potential to be developed and improved. The boys really do benefit from the therapy and I hope that the new induction folder will provide enough guidance for even therapists or therapy students with no experience to pick up and continue with the programme. Yes, you will need to work quite independently and this will be a challenging project but volunteers really will make a difference to improving the quality of life for these boys. And for those with experience (or confidence!) there is so much more potential for development – for example, the home also has several disabled men who would also benefit from therapeutic intervention.
Ultimately, Home of Hope is a challenging but rewarding placement and is desperately in need of volunteers (both therapy and care) to continue developing the newly established therapy programme.