Before I take you on an exploration of the wierd, wonderful and complex Vietnamese belief systems (I can almost hear the excited anticipation!) here's a couple of stories from November.
The first because you have to take the rough with the smooth, and I don't want you to think it's all fun fun fun....
After a good morning's work and a delicious noodle lunch in the sun with the kids, I went to use the toilet. It's a squat, in a mouldy low-roofed cupboard, with no working light, but I'm used to it and it's never normally a problem. But today, as I bared my bottom and squatted to pee, a rat poked it's head up through the hole in the toilet.
That's just too much.
Can you imagine what that's like?
So if you ever get jealous while you're reading about my (more fun) adventures here in Vietnam, just go and sit on a nice, clean, normal-height, rat-free toilet for a few minutes, remember this little story, and tell yourself how great life is.
And the second because it's good to laugh at yourself.....
Riding along on the back of a xe-om (a motorbike taxi - literal meaning 'go hug') I was chuckling cynically to myself at the state of the driver's helmet, which was completely cracked, with big chunks missing, and held together with thin wire. "Wow, this dude really doesn't get the point of a helmet, does he! You'd never see this in England. What a fool...." I thought.
Until I remembered that I was on the back of this man's motorbike. Wearing his spare helmet. And it was hardly going to be his better helmet, was it now.
On arriving, and being relieved to get there in one piece, I paid the man, gave him a small tip, said goodbye and headed off to meet a friend. He called me back, which is unusual, and was gesturing, with the money in his hand. I knew I'd paid enough. Why was he asking for more?
"No more, sorry brother. Bye" I said (in friendly Vietnamese) and turned away again.
He called me again and started waving his hands in the air.
"No more!" I said (a bit more firmly) and turned to walk away again, amazed at his persistance, it's really not common here, especially when you speak some of the language.
When he called me back for a third time, I couldn't help but get a bit angry inside and started to say pretty firmly (although I'd never make a scene, especially here, where it's just not done) and in a big-girl voice; "Now really, you know I paid enough, and I already gave you a tip, and I'm NOT giving you ANY MORE...."
when I realised that I was still wearing his dubious helmet, and he wanted it back.
I felt like a total dumbass. But then again, if he'd just said what he wanted....!
(VSO, I totally understand this helmet story is the reason why you have are rules about us wearing our UK provided, full-head, certified, stig-esque helmets. It won't happen again, I promise!)
Now get to the front of the queue for your tickets - the cultural smorgosbord of Vietnamese beliefs will be starting soon....
Sunday, November 21, 2010
Wednesday, November 10, 2010
A stay in hospital and our wonderful NHS
During my recent 5 day incarceration in the Hoi An Pacific Hospital, I had plenty of time to lie back and think about the unfairness of life. Not the unfairness of getting Dengue - that's just bad luck and having mega-delicious blood, but the unfairness of having vs. not having.
There was me, with my VSO medical insurance, in the 'International Department'. A big clean room to myself, with a spare bed, a private bathroom and the biggest TV I've seen in Viet Nam, a phone line direct to a nurse, and daily visits from the doctor. And then just down the corridor, in the 'normal' wards, were people 2 or 3 to a bed, with no mattress or sheets, who were lucky to see a nurse once a day, never mind a doctor.
This is what's unfair. Simply because of where I was born, and to whom, and because (via insurance) I have dollars, I have such different treatment when I'm sick.
We're all essentially the same. We're all people, we're all vulnerable, and we should all have the same access to healthcare irrespective of race, colour or money.
Here in Viet Nam, there is both Government and private healthcare provision, but you have to pay for either, and there's generally little difference in cost or service. There are private health insurance schemes, and there are some Government subsidies - children under 6 don't pay for basic healthcare, and the very poor, disabled, war veterans and poor elderly get some reduced rates.
My interpreter's father is very sick with a cardiac condition, and after two weeks in the local hospital he's had to go back home as they can't afford for him to be there any longer. When you're in hospital there is no personal care, and no food or drink are provided. So if you're sick, a member of your family has to stay in the hospital with you to take care of things. Another family wage lost....
People often don't buy the medicines they are prescribed, or they reduce the dosage - I regularly see children with epilepsy who have fits several times a day because their parents cut their tablets in half or quarter. They just can't afford to buy more.
If someone needs a wheelchair, they have to buy one, or try to find an organisation (Vietnamese or foreign) to buy one for them. Often their family will just carry them.
This picture is of the children's ward at the local hospital. It's unbearably hot. All these people are sleeping and eating in this room.
Whilst half-shielding painful eyes from the glow of the laptop, I watched Michael Moore's 'Sicko' - and was completely astounded by the money-grabbing and lack of humanity in the US healthcare / insurance system, where if you don't have (or can't get) insurance, or if your insurance can wriggle out of it, and you don't have money, you just don't get help when you're sick. Or you go bankrupt trying.
My experiences here are reconfirming my absolute belief in, and admiration of the UK's National Health Service. Although at times it's a rumbling, inefficient, hulking lump of an organisation - it's free healthcare for everyone. All we ever hear in the media about the NHS is the problems. The wasted money. The doctors who mess up. The beaurocracy. The waits. The IT systems. The constant re-structuring. The rising costs. And these things do need sorting out.
BUT... if you get sick in the UK, you'll be looked after. If you need drugs, sure there's a prescription charge, but it's tiny compared to the cost of the medication. If you need an operation, okay you might wait a while, but it'll be free, and you'll stay in a relatively clean (compared to other places in the world) hospital, for as long as you need to, with food and care and therapy at no cost. If you need follow up medical care at home, that's free too. If you need therapy, that's free. X-rays, CT scans, blood tests, examinations, biopsies, MRIs.... all free. If you need orthotics, or a wheelchair, or a hospital bed at home, they're free.
These things aren't deemed newsworthy. But they're incredible, and we should treasure and celebrate our NHS, despite it's faults.
There was me, with my VSO medical insurance, in the 'International Department'. A big clean room to myself, with a spare bed, a private bathroom and the biggest TV I've seen in Viet Nam, a phone line direct to a nurse, and daily visits from the doctor. And then just down the corridor, in the 'normal' wards, were people 2 or 3 to a bed, with no mattress or sheets, who were lucky to see a nurse once a day, never mind a doctor.
This is what's unfair. Simply because of where I was born, and to whom, and because (via insurance) I have dollars, I have such different treatment when I'm sick.
We're all essentially the same. We're all people, we're all vulnerable, and we should all have the same access to healthcare irrespective of race, colour or money.
Here in Viet Nam, there is both Government and private healthcare provision, but you have to pay for either, and there's generally little difference in cost or service. There are private health insurance schemes, and there are some Government subsidies - children under 6 don't pay for basic healthcare, and the very poor, disabled, war veterans and poor elderly get some reduced rates.
My interpreter's father is very sick with a cardiac condition, and after two weeks in the local hospital he's had to go back home as they can't afford for him to be there any longer. When you're in hospital there is no personal care, and no food or drink are provided. So if you're sick, a member of your family has to stay in the hospital with you to take care of things. Another family wage lost....
People often don't buy the medicines they are prescribed, or they reduce the dosage - I regularly see children with epilepsy who have fits several times a day because their parents cut their tablets in half or quarter. They just can't afford to buy more.
If someone needs a wheelchair, they have to buy one, or try to find an organisation (Vietnamese or foreign) to buy one for them. Often their family will just carry them.
This picture is of the children's ward at the local hospital. It's unbearably hot. All these people are sleeping and eating in this room.
Whilst half-shielding painful eyes from the glow of the laptop, I watched Michael Moore's 'Sicko' - and was completely astounded by the money-grabbing and lack of humanity in the US healthcare / insurance system, where if you don't have (or can't get) insurance, or if your insurance can wriggle out of it, and you don't have money, you just don't get help when you're sick. Or you go bankrupt trying.
My experiences here are reconfirming my absolute belief in, and admiration of the UK's National Health Service. Although at times it's a rumbling, inefficient, hulking lump of an organisation - it's free healthcare for everyone. All we ever hear in the media about the NHS is the problems. The wasted money. The doctors who mess up. The beaurocracy. The waits. The IT systems. The constant re-structuring. The rising costs. And these things do need sorting out.
BUT... if you get sick in the UK, you'll be looked after. If you need drugs, sure there's a prescription charge, but it's tiny compared to the cost of the medication. If you need an operation, okay you might wait a while, but it'll be free, and you'll stay in a relatively clean (compared to other places in the world) hospital, for as long as you need to, with food and care and therapy at no cost. If you need follow up medical care at home, that's free too. If you need therapy, that's free. X-rays, CT scans, blood tests, examinations, biopsies, MRIs.... all free. If you need orthotics, or a wheelchair, or a hospital bed at home, they're free.
These things aren't deemed newsworthy. But they're incredible, and we should treasure and celebrate our NHS, despite it's faults.
A comparison of a working day
Morning
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)
Breakfast
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.
Lunchtime
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
Meetings
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....
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)
Breakfast
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.
Lunchtime
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
Meetings
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....
a weekend of culture....(and dancing)
Having met Kathy and David in Heathrow airport on the way to this Vietnamese adventure, it's very sad that they're about to finish up their placements in Hanoi and go back to the UK. Being alone, far from home, and in a very unfamiliar culture, they've been a big support to me and the rest of our little starting-out group. So to say goodbye, the six of us met up together for a weekend in Huế, central Vietnam. One of the wettest cities in Asia. In the middle of the rainy season. Whose idea was that?????
The city is green and aesthetically pleasing, with the Perfume river winding through the middle, and lots of parks and ornamental gardens with footpaths running through and round them. The streets are very very clean, and much less crowded than Hanoi or Saigon. If it ever stops raining I'll go back and spend time walking around.
Following hours walking around in the rain, our good friend mister Shimpei decided to make use of the hotel sauna and massage service. The sauna turned out to be 10 minutes shivering in a lukewarm cupboard, and the massage was, in his words, 3 minutes of "rubbing, scratching, and pinching" in a very seedy little room. When the young lady climbed astride him, pointing to his lower region and saying..... "bay-bee? bay-bee?", he claims to be pretty sure that she was offering an extra service and not just being descriptive, and escaped as fast as he could! Despite him turning down her lurid advances, we'll be calling him 'baby' for the rest of his life. Hahaha.
So the rain continued, but couldn't put a dampener on the evening, as we feasted at a popular local vegetarian restaurant, with the torrential rain hammering the metal roof. Huế has quite a lot of fairly devout Buddhists, and therefore has more vegetarian eateries than any other city in Viet Nam. Who'd have guessed that savoury fried sesame jackfruit would be so tasty?
And after dinner we made our way to an actual nightclub, where 'happy hour' lasted from when we arrived until we'd danced our socks off, every guy had tried and failed to chat Sarah up, and we'd finished the bar's stocks of sambuca. Good times.
I spent Sunday night with some volunteers living in Huế and some of their local friends. This was an adventure, consisting of beers at the backpacker hostel, local street food,
an hour at the Miss Hue University beauty pageant (degrading, chauvanistic and UNBELIEVABLY slow, but an experience. Cameras and lights and sparkles and celebrities and gold suits and screaming ahoy).....
......followed by late night exploring of the city on scooters in search of sinh to, sheltering under low plastic sheeting to crowd round a tiny table to eat hot sweet fried goodies, more scootering, more street food and finally to bed.... fun fun fun in the, er, rain rain rain
I somehow slept all the way back back to Tam Ky on Monday morning (when the ticket says 'hard seat' they're not joking, and the smell of dried squid was pretty intense)....
....and then slept through most of the cultural show I was invited to attend that afternoon. Local government and Party officials and university directors were gathered for endless speeches, dancing, singing and a large buffet. I was almost dribbling with tiredness, and for the first time since university lectures was doing the thing where you fight sleep until your head drops down, waking you up, and you quickly look around to see if anyone has noticed. Know what I mean?
And the rest of you - see you at Christmas!!
Sunday, October 10, 2010
progress with the lingo...
My Vietnamese is steadily improving. At least I feel like it is.
I do, however, have some concerns about my pronunciation and spelling. In this central region there's a very strong, drawling, farmer's accent, and my most dedicated and enthusiatic teachers are a young lady with a harelip, a girl who is deaf, and a man with dyslexia.
I guess this might equate to someone learning English by living and working in a special school in deepest darkest Somerset for a year...
I do, however, have some concerns about my pronunciation and spelling. In this central region there's a very strong, drawling, farmer's accent, and my most dedicated and enthusiatic teachers are a young lady with a harelip, a girl who is deaf, and a man with dyslexia.
I guess this might equate to someone learning English by living and working in a special school in deepest darkest Somerset for a year...
Thursday, October 7, 2010
X-rated chair
In retrospect, indiscriminately tearing up a friend's copy of Vanity Fair to cover a young child's seat was not a very good idea. It's now displaying some very tawdry and lurid details about Tiger Woods' shenanigans. OK so no-one can understand, but I still feel it's a bit inappropriate...
Thursday, September 30, 2010
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).
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.
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.....
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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