Wednesday, November 10, 2010

A comparison of a working day

UK - struggle to get out of bed when the alarm goes at 7.30, hot shower, breakfast, iron uniform, find socks, boots, jumper, coat, scarf, gloves, scrape ice from the car.
Vietnam - wake up with the cockeral and public loudspeakers at around 5.30, yoga, cold shower, throw on shorts, T-shirt and flipflops. Find my bike (which has often been appropriated by one of the family to go to the coffee shop or to play football)

UK - tea and porridge at home
Vietnam - fresh iced soy milk and beef noodle soup on the street on the way to work, or meet with colleagues for savoury pancakes.

Journey to work
UK - 20-30 minutes by car or mountain bike, queues and traffic lights on the Wolverhampton road, problems finding parking, 10 minutes finding the paperwork I need in my very messy car.
Vietnam - 5 minutes on my bike, dodging motorbikes, dogs, floods, potholes (what are these animals, Bry?) No paperwork to find.

Home visit
UK - make sure someone knows where you're going, check alerts and make sure visit is entered on the computer system, unlock filing system and review clinical notes, phone to confirm interpreter, collect appropriate equipment, record mileage and postcode of destination, check you're wearing a coat which covers your uniform, check you have your ID badge prominently displayed, set out in the car using A-Z to negotiate Walsall. Arrive and park so that you can see your car from the house, and secure any valuables in the boot out of sight. If you're lucky and there's someone in, you're likely to get complaints about services, schools or waiting for something. Neighbours couldn't care less if you're visiting, unless you're in their parking space. Heating and soap opera on full blast. Check the child's multiple special chairs, orthotics,  standing frame and hoist. While there, phone the Consultant's secretary with a query about the date for follow-up. Provide printed exercise and advice sheets, and arrange the next visit. On returning to the office, confirm and code the visit on the computer system, and write comprehensive notes by hand within 48 hours in case of litigation. Next visit..... 
(4-5 visits per day, per therapist)

Vietnam - meet interpreter at coffee shop. Have iced coffee while waiting for a few more people. Pile on motorbikes. Realise no-one knows where the child lives. Wait while someone goes back to the centre to find a phone number and get a rough address. Set off in the opposite direction. Stop at a market where someone buys fruit. Go back in the right direction. Stop because we've lost a motorbike. Phone them. All catch up, person who was left behind now carrying six empty 4-litre plastic bottles and a child. Stop at another market for something. Turn off the road onto a dirt track. Get to a large expanse of water. 

Try to put the motorbikes onto tiny wooden boats and fail. Leave the bikes, and climb on. People, helmets, bags, bottles, fruit, and child.

Marvel at the muscles on the elderly lady paddling us across. Get to the other side. Fight over who pays (everyone's trying to). Walk through palm trees, cactii and pines. More motorbikes appear from somewhere. Climb on (3 on each). Arrive in a village, and stop at a house. Quickly realise this isn't a house with a child requiring therapy. Offer appropriate condolances, light incense sticks and put fruit on the altar for the recently departed. Set off again after drinking tea. Arrive at another house. Walk through their garden to the shack behind. Finally - a familiy with a child with a disability. Neighbours and relatives gather to watch - squatting in doorways and clambering at windows. House built for ventilation, with mosquitos and gheckos joining the party. Assess child on the thin mat on the floor where the family sleep.

Try to get the local therapy worker to get involved rather than watch the loud and very distorted soap opera blaring out from the TV. Drink fresh coconut milk, and eat hot Vietnamese 'donuts' brought by the aunt. Cut the legs off a plastic stool with a penknife, give advice via interpreter, and draw pictures in biro in a school notebook. Investigate the wheelchair sitting rusting in the back garden, which still works fine, and suggest that we might use it for another child. Fix it onto the back of a motorbike. Lunchtime. But we set off in another direction. "Do we have another visit?" "No". "OK, where are we going?". "To make a visit Nhi's parents". As if it was a very stupid question. Arrive for a 10 minute visit. Drink tea. Have lunch. "Are we going now?" "Now we rest". Of course.

2 hours and a nap with grandma later, the bottles are filled with home-made fish sauce and we're all loaded back on. I drive a motorbike round the garden and everyone laughs when I crash into a fence. At some point we deposit the borrowed bikes back, walk again, and get to the water. Back on the boat, retrieve the original bikes, and weave our way back to the centre. Everyone lies around in exhaustion and wonderment at how much work we've done. "Thank goodness we don't have to do that every day" they say... "Oh my god"
(4-5 therapists, one international volunteer,1 visit per day!)

School visits 
UK - sign in, showing identification and CBR certification. Meet with child and their dedicated 'LSP' (learning support practitioner). Discuss progress and/or concerns. Meet with teacher if needed. Update their daily therapy activity programme. Arrange a review with their speech therapist, their occupational therapist, their educational psychologist, their paediatrician and their wheelchair specialist. Provide information for their educational review. Write notes and put on the computer system.
Vietnam - dream on. A child who can't fend for themselves and get around independently won't be in school.

UK - half an hour to eat a sandwich or salad, often in the car or the office
Vietnam - 2 to 3 hour break in the middle of the day. Leisurely cycle home for a feast of rice, veg and fish with the family, and a nice long nap

UK - efficient, agenda-ed, to the point, effective, democratic. Generally people paying attention and things get decided.
Vietnam - slow, circular discussion, authoritarian, people smoking and answering their phones, not much gets decided.

After work
UK - back in the car, back on the busy road, home.
Vietnam - to the market with colleagues for fresh passionfruit juice and hot banana and coconut fritters. Home in 5 minutes, and then a ride to the beach for a swim....

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