Why expensive equipment isn’t always the best thing…..

If you think about a day centre for kids with disabilities, you'll probably imagine rooms full of wheelchairs, mats, balls, parallel bars, frames, special seating, rolls, wedges…..

When disability centres are being established in developing countries, the initial focus is often on buying equipment. On filling the rooms with “things” to help the children.

Big deliveries arrive from the capital, paid for with foreign funds; shiny and brightly coloured and expensive and attractive.

This is completely understandable, and always done with positive intentions. But I’m going to suggest that putting all this ‘stuff’ into a poor rural day centre doesn’t actually help. In my opinion it causes a problem....

Parents start to bring their children to the centre for therapy. There’s a therapist, who (with varying levels of understanding and ability) uses the equipment for activities and games to help the children’s development. The parents watch and are happy. But this approach, whilst fun and beneficial for the child, encourages the parents to view ‘therapy’ as ‘what the child does with the therapist, using equipment, at the centre’. They are led to believe that therapy can only be done by someone with training and a ‘title’, using the expensive mats and rolls and wedges and seats from the city.

During the rainy season, or the harvest time, or a national holiday, or when it’s too cold, or too hot, or too misty, or the winds in the wrong direction… the family might only attend the centre once every three or four weeks. So if the child’s therapy is limited to what they do at the centre, they’ll only be engaged in activities to help their development for a few hours every three or four weeks. The rest of the time, during normal life at home, they will often just lie on their backs on the floor or on a hard bed.

In order for a child with a disability to develop to their potential, their parents need to become ‘therapists’. The parents need to understand that ‘therapy’ is a way of thinking. That therapy can, and should be, incorporated into absolutely everything a child does in daily life.

Therapy is the position a child sleeps in. The way you pick them up when they’re small. The way you don’t pick them up when they’re bigger. It’s the way you talk to them. The things you ask them to do for themselves instead of doing for them. It’s the pillow you tuck under their arms, or between their legs. It’s the direction you put them to lie on the day bed. The way you feed them, or help them to feed themselves. It’s the way you carry them, or don’t. The way they sit on the floor, or don’t. The things you encourage them to play with. The things you encourage, and the things you don’t let them do.

Parents (and families) need to adjust and commit to constantly thinking about how to make everyday life ‘therapeutic’ – or an opportunity for their child to learn new skills.

These families cannot afford big deliveries of shiny, expensive equipment for their homes. They’re certainly not going to get it for free from a National Health Service like families do in the UK. They have what’s available from the market. They have plastic stools and tables, available in one height only. They have blankets. They have bamboo mats. They have pillows. They have washing baskets. They have bowls and spoons. They have cardboard boxes and the packing inside them. If they splash out a bit and visit a bookshop they can get playing cards and crayons and colouring books. They have walls and windows and steps and bamboo growing outside.

My point is that therapy centres, and therapists, in poor rural areas of developing countries should focus on teaching families positions and activities that they can easily replicate at home, making creative use of things that are easily and locally available, rather than demostrating the use of expensive (and often imported) equipment from the cities. They need to think long-term. And local. And self-reliant, rather then dependent on outside funds, which are all-too-easily pulled.

If things from the market things break, as they do, they can be easily replaced, and life and therapy goes on….

If a child grows too big for a set of bamboo walking rails, then the family can cut some more bamboo and make a larger set.

If a child is using a home-made cardboard chair, and develops better sitting balance, the family can make a new chair that doesn’t have so much support.

If a childs needs more support in the wooden standing frame made by the carpenter in the village, then the family can take it back to the carpenter in the village and ask him to add some.

(Having said this, there are some pieces of equipment which are very important for the development of any child with more severe physical difficulties – specialist wheelchairs, plastic orthotics (splints) and walking aids for example - which should be made to measure and are best provided by people who know what they’re doing. I'm not about to start knitting walking frames....)

So my advice to organisations setting up rural therapy centres - think about your aims.

If your aim is to provide top-quality therapy in your centre, then grab your catalogues and get ordering.

If your aim is to teach families how to bring out the potential in their child, then think about holding back. Hit the market instead.