Cardboard seats?

Why does seating matter?

Some disabled children have a really hard time controlling their bodies. When working with physical disability, the most common problem we come across is cerebral palsy (CP). CP is the name given to disability caused by injury to a child’s brain during the mother’s pregnancy, during birth, or soon afterwards. It's a problem all over the world, although rates are higher where pre-natal and birth care is not very good, and where doctors prescribe high levels of drugs to expectant mothers (amongst other problems).

Like with a stroke or a brain injury in an adult, the amount and area of damage to the brain determines what type and degree of problems the child experiences. CP can range from children with normal behaviour and learning and just very mild movement problems, to children with significant problems with movement, sensation and thinking.

For some children with CP, the injury damages the part of the brain which helps them to hold themselves upright (the bit that sends signals to the postural muscles). For some of these children, the signals for 'activity' don't get produced, so they're floppy. For other children the signals aren't regulated properly, and so their muscles are overactive. They might arch back, straighten and/or cross their legs, and/or their arms might take unusual positions.



From David Werner's 'Disabled Village Children'

 

To get an idea what this lack of postural balance might feel like for a child (and I often get the staff and parents to try this….) imagine sitting on a gym ball - one of those big bouncy exercise balls - and lifting your feet off the floor. Then w­­­hile you’re trying to balance, try to colour in a picture. Or write your name. Or put on your clothes. Or eat a meal. It’d be pretty difficult, right?

Well that’s how things are for a child who has a problem ­with their postural muscles. When you sit them on an ordinary stool or chair, it takes everything they’ve got to try and stay upright, never mind to concentrate on swallowing their food, or gripping a pencil, or stacking bricks. They can’t concentrate on developing their functional skills (eating and drinking for example), their 'fine motor' skills (small movements with the hands), or their speaking or swallowing skills, because they don’t have a stable base to start from. They’re simply trying to balance.
They feel vulnerable, and they are. This feeling of insecurity makes their muscles misbehave even more (again – think about what you’re arms and legs would do if you try to sit and balance on a wobbly gym ball).

So…. in order to give children like this some stability, some balance.... we have to give them good seating. They need suitably sized, suitably supportive chairs. Some children need straps. Some need the seat to be sloped downwards towards the back (to stop them arching their body back). Some need head-rests. Some need arm rests.  

When these kids are properly supported in a sitting position, without having to work too hard, they suddenly have the opportunity to use their hands. To work at holding their head up. To concentrate their efforts on swallowing their food or practicing speech.

Surely they have chairs in Vietnam? Why bother making them?

In the UK, children with CP can get an astonishing array of fantastic specialist seats, for free, courtesy of our quite incredible NHS. But here in Vietnam, ‘seating’ for kids generally means the floor, or whatever plastic seating is available at the market. So you often see adults squatting on tiny stools, and children perched high up on bar stools. The standard sized seats and tables are far too big for children. For kids who can balance well, the solution is simply to cut the legs of the plastic chairs and tables. But for the children who can't balance the options are;

1) Sit them on the floor or whatever seat you've got around.

2) Save up and order specialist seating from Hanoi or HCMC - around $100 for a very basic chair, off the shelf, which may or may not fit well. Then it's a few weeks wait and an expensive delivery (1000+ km). In a years time, when the child has grown too big for it, save up another $100..... and order another one (bear in mind some families are living on around $2-3 per day).

3) Try to find a kind charity or organisation to order one for you. And another one in a year's time. Then another one....

or 4) Make your own seats to measure.....

So, one of my main focuses here has been to teach the therapist and volunteers how to make strong, durable, made-to-measure chairs from cheap (or free) locally available materials.

I attribute all the techniques we’re using here to the late Bevill Packer and the very much alive and inspiring Jean Westmacott, who refined these methods in Zimbabwe and other countries. Jean runs training programmes in the UK and abroad, and has generously made their advice and instructions freely available on the web. Please see ‘www.cerebralpalsyafrica.org/APT_Programmes’ or search for 'appropriate paper based technology' for more information on their projects.

Cardboard is everywhere in Vietnam. Thanks to the prolific smoking of the adult male population, there are huge ‘Bastos’ and ‘White Horse’ boxes discarded outside every small shop. And the only glue we need is made from flour – here we’re using cassava flour, but you could use rice or wheat flour.

The only cost is around 6,000 VND (£0.20p) for the bag of flour, and then coloured paper, stickers, varnish or whatever you want to cover the chair with.

It’s basically just papier-mache, on a large scale, with some structural engineering thrown in. And it’s a lot of fun.

The first stage is to make strong, thick boards. This is done by layering large pieces of corrugated cardboard in alternate directions. We’re using 3 or 4 layers, depending on the thickness.

These are pasted together with cassava glue, which is made by adding boiling water to a paste of flour and cold water. The kids love helping with the pasting.

Then we dry the boards under tables and weights outside in the Vietnamese sun. They need turning over regularly, and dry in around 3 days.

Once the boards are dry, we measure the child and cut the pieces to the appropriate size. The sides are tensioned together with rods with splayed ends.

All the joints are then glued and re-enforced with ‘angle irons’ made from thinner cardboard.

Edges are covered with strips of magazine or newspaper, and once dry, the chair is ready for a layer of tougher paper, paint, varnish......

......in any colour or design the child ­chooses!

Straps can be made very cheaply by tailors at the market, and it's easy to cut holes through the back or sides to attach them.

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The therapist is currently making her first chair completely independently, and I really hope that she will carry on making seating for the children in the area. It makes such a difference to their lives and to their development. Maybe some of the families can learn from her, so that when their child grows, they can make new chairs themselves…..

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6 months in...

... and it now seems completely normal;


- to meet a friend for breakfast at 6.30am on a Sunday morning

- to eat fish, shrimp, garlic and chilli for breakfast at 6.30 on a Sunday morning

- for people to ­wear pyjamas all day long

- to feel naked leaving the house ­without a hat and sunglasses

- to have a nap every day after lunch

- to stand up in a (mini)bus on long journeys 

- to hear 'happy birthday', 'jingle bells', 'auld lang syne' and 'deck the halls' chiming chirpily from the rubbish truck



- to be asked if I kno­w rooney

- for coffee to come ­with ice and condensed milk

- to have to get things signed and stamped by a million people before you can do anything

- have school children hide behind bushes to take your picture on their mobile phone (I'm a celebrity, doncha kno­w)

- for 9pm to be a late night!- to take cold sho­wers

Food - the next installment

Hello people! 

Sorry... before I give you pictures and recipes, I know I already talked about this in my first blog about food, but, well... life here is having a big impact on me. I want to talk more about corporate vs. local food production. I know that you guys, my fabulous friends, are already engaged with the world, and give thought to how your lifestyle choices affect you, your community and the planet we live on. So I know I'm preaching to the converted, and you don't need to read this. But well, it's just.... if you're not particularly, or you don't particularly..... please read, and give it a little bit of thought.

Here in Vietnam, more than 70% of people still make their living directly from the land. In this area, even the people working in office jobs, industry or running small businesses also keep animals, and grow rice and vegetables at the home. Admittedly things are different in the cities; supermarkets are becoming more common and I've heard that meat, fruit and dairy products are being imported from China for the growing middle-class urban market. But still.... the vast majority of the Vietnamese population still live in rural areas, surrounded by the beauty of the rice paddies. Their lives are entwined with the cycle of sowing and growing. People (especially the women, who do most of the work) are tough and lean and incredibly strong from physical work. Food is as fresh as can be, and (other than seafood) doesn't travel far from field to bowl. Communities are still sustained by the camaradery forged through physical work, with families and neighbours joining together during strenuous periods of labour. The local market is the still the buzzing hub of every village - with people calling in daily to buy what they need for the evening's meal. Small street restaurants are everywhere, and Vietnamese people are very (and quite rightly) pround of their food.

I need to be careful when I describe all this, because I fully understand that things are not perfect here. Not by a long way. This rural lifestyle, whilst seeming so idyllic to me.... healthy, beautiful and essentially sustaining and sustainable; is very tough, and not lived by choice. It's forced, by limited financial resources and systemic repression. I understand why families who have farmed for generations, for centuries, want their children to do well in school so that they can get good jobs in offices. With computers. And, depending on the family, either enough or lots of money.

It's really difficult to speak about this without feeling and seeming patronising. I've never had to live on 2 dollars a day. I don't have a family to feed. I don't have children to think about. I haven't had to work in fields my whole life, and I don't have blisters on my hands. I've had a comfortable upbringing and a full education. I have a degree, a van, an iPOD and a laptop. And so it feels ungrateful to discuss any negative aspects of life in the UK. But I think it's important that people here balance their aspirations of urban lifestyles and material wealth with an appreciation of some of the positives of their current lifestyles, and some of the problems which can so easily accompany the transition.

As an example, in Britain (and I'm sure I can say the same for the US), the vast majority of people have become completely detached from where their food comes from. According to Colin Tudge from the Campaign for Real Farming, less than 1% of the total workforce in Britain and the US is working on the land, and in Britain the average age of farmers is approaching 60. I'm embarrassed to say I can count on one hand the number of farmers I know personally in the UK. Wandering (ok... sitting snacking) in the vibrant markets here, listening to the chatter and bartering, I think about the admittedly convenient, but very depressing behemoths that are supermarkets at home, and about the sad-faced people trudging their aisles for cheap deals on heavily packaged, anonymous, chemically-treated and far-too-often imported foods. People here can't comprehend that a lot of people in the UK rarely buy fresh food. That a huge number of people have major preventable health problems caused by unhealthy diets and lack of exercise. That some people rarely go outside in the fresh air.

(That's not to say that Vietnam doesn't have preventable health problems, don't get me wrong - cancer, diabetes and heart disease are major and growing problems here, but I would say that at the moment, the average Vietnamese diet is far healthier than your average Brit's...)

I don't talk about these things to be critical of home. There are so many things about life in the UK that we can and definately should be grateful for. I just really hope that as more people here enjoy office jobs, more money, more free time and more stuff, they keep in mind the real (but judging by the West, all-too-easily forgettable) benefits of the agrarian, land-connected life they risk leaving behind.  And on the other side of the world, I hope that the UK continues to re-awaken,­ re-learn, and re-build our connection with our land and food production. Optimistically, there are many deeply committed people and organisations ­working at encouraging this - lets just hope the mainstream accepts the idea. On a personal level, I'm deeply appreciating living in and amongst the produce which nourishes me so w­­ell, and I'll be making every effort to adjust my life to the same w­hen I get back.

(As an aside, I keep ­wondering w­hether there's any ­way the UK could tie-in unemployment and state benefits with people learning about and growing food. Hmmmm.....)

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Here, animals are animals before they're food.

As in the UK, Vietnamese love to eat meat. Now that people have a bit more money, practically every dish at meal includes meat or fish. Although I'm sure there are some larger scale operations somewhere in Vietnam, in the rural areas animals are raised in and around family homes. Meat is generally taken to the village markets by the person who raised the animal. It's slaughtered, bought, cooked and eaten within hours. OK, so it is often served complete with bones, and tendons, and sinews and skin (which to our sensitised Western tastes might be 'disgusting'), but it's healthy, natural, and tastes great. I personally feel that our apathy towards treatment of animals and farmers at home is far more 'disgusting' than picking bones out of my chicken noodle soup. Now I know that there is simply not the option to buy cheap factory-farmed meat here. Being a tad cynical, I think that if there were supermarkets selling the stuff, then Vietnamese would probably buy it. Families here have to spend a significant amount of their daily budget on food. But they're spending it on good healthy local produce, the production of which doesn't harm the environment in the same way that our 'Western' mono-culturing, globalising, profit-driven corporate food production does.
(The problems with food safety here are far more often due to lack of know­­­ledge about nutrition and clean food preparation rather than the basic health of produce.)

Anyway, enough blabbering on.... here's some more food descriptions, pictures and vague recipes

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Vietnamese chickens can be pretty scrawny birds, but around here they're as free-range as the children are. They peck at whatever they fancy. They wake everyone up at 5.30am. They get an occasional kick when they cluck around under the table while people are eating breakfast (not from me, I should add). They grow when they're ready. They lay eggs when they're ready. They ride on the back of bikes and motorbikes, and are sold live and kicking at the market.

 My favourite chicken dish has got to be 'mỳ gà'. This is a dish of the same thick fat rice noodles as in 'mỳ Quảng' (described in my last post on food), with chicken pieces and broth rich and full of flavour, with lemongrass, garlic and chilli. To this is added fresh salad leaves, herbs, roasted peanuts, more chilli, nước mắm­­ (fish sauce)­ and broken up sesame rice crackers.

Another good chicken dish is a simple plate of slow­-boiled, shredded chicken with cilantro (you could use Asian basil), mint, onion (boiled with­­­­­­ the chicken) ­­­and plenty of black pepper.

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 Pigs are normally kept in enclosures at the back of houses, open to sunshine and air. They're fed on food scraps, vegetables, dried casssava and rice husks. 

When they're slaughtered, absolutely nothing is wasted. Although I'm not particularly partial to pig's knee noodle soup (bùn gìo heo), or congealed pigs blood soup (cháo huyết), these make very cheap nutricious meals and are very popular. (I should mention that in more urban regions where they have abattoirs, the procedures seem pretty unhygenic, and I've heard that the workers often get ill. Health and safety is not yet much of a concern here.

When it comes to pork dishes, there are so many good ones I don't kno­­w w­­­­here to start. 'Bún thịt nướng' is a widely available favourite in this area - the translation is literally 'noodle meat barbeque', and consists of a bowl of fresh salad leaves, herbs and cold thin ­­­­wh­­ite string-like noodles, topped with flattened, marinated barbequed pork, cucumber slices, crispy rice things that look like quavers, crushed peanuts, beansprouts and slivers of blanched carrot and pickled savoury melon. The marinade is incredible - lemongrass, shallots, chilli, soy sauce, fish sauce, sugar, pepper, lime juice.... all the flavours of Vietnam. This ­­will be a perfect dish for barbeques next summer. Who's in? 

It's really hard to make this dish look nice in a photo. But trust me, it's soooooooo delicious.

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 In the mornings, I like to stop on my bike to watch the long wandering lines of ducks as they're led from their sleeping enclosures to the rice paddies, where they are free to roam until evening when they're led back to nest.

Duck is quite a delicacy, and the meat is full of flavour. Of course, restaurants don't mess about with only serving the bland white bits. When you ask for duck you normally get a platter with the chopped-up bird (and I do mean the entire bird, chopped up; bones, head, skin, feet, everything), a side plate with the gently fried and seasoned insides (organs and part-formed eggs - pretty tasty) and a rice soup with the blood poured in (I tend to give this bit a miss). Sorry, no photo yet. I'll update next time I'm, er, 'treated'...

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Cows are all over the place. They’re sometimes tethered on long ropes in areas of grass and bushes, but often seem to just wander where they like. I'm sure children don't appreciate the family cows when they're sent out to fetch them from the fields before tea, but I certainly do. Sure they're lean and bony, but they're healthy, with shiny eyes. There's no confinement, chemicals or corn-feeding for these animals, and again, every part is used when the family decides it's time to slaughter one. I can't find out ­why, but co­ws here are only kept for meat, never for dairy products. Milk and yoghurt comes in boxes, al­ways ­with at least 9% added sugar. It's expensive, and only really drunk by children. Cheese is almost unheard of, and butter is neither available or ­required.

Beef is cooked in so many delicious ways, it's hard to pick my favourite. 'Phở bò' is the obvious one - but I've talked about that before. 'Bún bò' is paper-thin slices of lean beef in a thin-noodle-laden broth - I often have this for breakfast, w­­ith added chilli of course!

A special celebration dish is tenderised, flattened beef, wrapped in leaves that look like spinach but aren't, and flash fried. Another common way to use beef is to add small slices to stir-fried green beans or broccoli. Again, I'll add photos as I take them.

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If you look at the shape of Vietnam, most of the country is relatively close to the sea, and fishing is a livelihood for a lot of people here. Market sellers make an early morning 5km trip to the beach w­ith ice boxes, returning with fantastic shrimp, squid, clams, crab....

On a recent family visit, the child's father (a fisherman) quickly grilled some dried squid, ­which ­we devoured hot, torn into strips and dipped in potent, chilli-laden nước chấm (fish sauce).

One of my favourite seafood dishes is 'lẫu tươi sông' ­which is basically a big pan of soup ­brought to the table and kept boiling over a heat source (either a candle or a gas flame) - in ­which you cook all sorts of fresh seafood, egg and vegetables (of course you can get variations including fish, chicken, tofu or whatever else you feel like throwing in).

Around here, this delicious soup is served in small bowls, ­with bun noodles. Everyone refills everyone else's bo­wls, until everyone is so full they can't move. Work tends to happen quite slow­ly after a lunch of 'lẫu'.

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Vegetables....

....are every­­where. They're grown all around houses, and in large areas in the fields.

They're taken to market on backs, over shoulders in baskets, loaded in hand-pulled carts and piled onto motorbikes. They're mainly sold by ladies with deeply lined faces, sharp eyes, grubby fingers and suprising smiles. The veg will have been picked the day you buy it, complete with dirt and reassuring small holes that show that the smallest village inhabitants haven't been detered.

Dark green, light green, red, purple, yellow, bitter, succulent, strange-looking, bland, spicy.... cooked up into soups and spring rolls, stir-fried, steamed, shredded, pickled, wrapped, chopped, boiled, sweetened, mashed, salted, dried.... I could go on and on.....

I think I'll do another post just on the crazy fruit and veg. And there's a whole world of breakfasts to talk about at a later date..... this one's gone on far too long already, and has made me very very hungry.

   

Now,­­ what shall I have for dinner.....  :o)   

work....

OK, so I know I promised the next post would be about food, but I'm going to make you wait until you've read some more about my work. Mwah ha ha.... 

But don't worry - this one's mainly pictures of what we're up to.

Welcome to Nui Thanh centre!

Having felt at the beginning that this placement just wasn't going to achive anything, it's turned out to be amazing. We're making good progress, and I wish I had longer here. It's mainly informal training with the therapist (in glasses here) and the families, but I'm also doing more structured sessions with local women who volunteer their time to visit children who can't get to the centre.

 

Days at the centre are full of fun and games. 

I promise you, the little girl below IS having fun...

This is her "I'm having fun" face. Her cerebral palsy just makes it difficult to smile. 

Can you guess what colour we had to make her special chair?

 

This 14 year old young man had never held a pencil or a crayon in his life. Why? No-one thought he could. He draws every day now, but it's a battle to get anyone to let him try things. This one's really getting to me. He could learn to do so much if people believed in him.

This mother is absolutely incredible. Her little boy is quite severely disabled with cerebral palsy, but they communicate like they're reading each other's minds. I love watching them laughing when they balance on her old bicycle. She works very very hard with him, and she'd do anything for him.

 

We're also doing a lot of home visits, which are always humbling and unpredictable. At this very remote shack on the side of a mountain, we were treated to an hour-long feast, home brew (lethal), guavas and bananas from the tree outside, cassavas from the garden to take back to the centre, and beds and hammocks to rest in. Work certainly wan't like this in West Bromwich!

This family have a devastating story... they had two healthy normal children, then the husband went to Cambodia with the Vietnamese army (as they fought to end the brutal reign of the Khmer Rouge). On his return, they both felt that they wanted more children, so had two more, and both have cerebral palsy with severe learning disabilities. Almost certainly related to the amount of Dioxin in the areas where the soldiers were based.

 

This little boy was born with club feet, which are being managed well by the Orthopaedic Hospital in Da Nang. The only problem is that families have to go and stay in the city, pay for all the treatment and orthotics, and the children often need input until they are 5 or 6 years old, sometimes longer. For families whose incomes are often only enough to just get by, it really causes them a lot of difficulty. Although it has it's problems, the NHS is pretty special...

The little girl on the far right has severe burns to both her legs, but functionally she's fine. I was sad to discharge her from the centre, as she was a little ray of light, but she's far better off going to school. 

As you can probably tell, I love this job. Good times. 

  and the next blog will be about food.... I promise