BI-ANNUAL

PROGRESS REPORT

January – July 2013

Growing the Nations Therapy Programmes | Bi-Annual Progress Report July 2013 2

July’13

Bi-Annual Progress Report CEO NOTE OF THANKS

Dear Reader,

I hope you find a smile on your face as you read this report, because as I write it I am smiling. It

brings with it news of change and stories of hope.

I would like to thank the people who emotionally, practically, financially and through prayer

support our Madagascar project, and without who the work will not be successful: My Family, The

Board of Directors, The Ministry of Public Health Non-Communicable Diseases in Madagascar,

Common Ground Church and the Common Good Foundation, Tana City Church, The University of

Cape Town, OTARG, WFOT, Me Julia Weiss and Me Tatiana who came to volunteer with us earlier

the year, and the many individuals who participate in the project in various different ways.

Your contributions make our work in Madagascar possible and I would like to thank you,

personally and on behalf of every family whose life we intersect, for this. I pray that God will be

glorified through this work of service.

Anri-Louise Oosthuizen

AMET

The Malagasy Occupational Therapy Association (AMET) is in

the process of applying for membership at the World

Federation for Occupational Therapy (WFOT).

AMET was started in 2012 by a group of health-care

professionals committed to the development of occupational

therapy in Madagascar. The process of becoming a WFOT

member country involves the constitution being evaluated by a

panel, a period for making adjustments, and submission for

membership at the next WFOT Council meeting. AMET hopes

to receive WFOT membership in 2014. Thank you Ilse-Marie and Design by Invitation for the beautiful logo.

Growing the Nations Therapy Programmes | Bi-Annual Progress Report July 2013 3

July’13

Bi-Annual Progress Report ADMINISTRATION

This is a season of administration, putting in place systems and procedures … page by page. Our

main focus is two-fold: Applying for a head-office in Madagascar, and discussing a convention with

the Ministry of Public Health in order to train occupational therapists in Madagascar.

The head-office agreement is a slow process due to our activities being located in different municipal

areas, districts, and regions in the greater Antananarivo. The convention has passed its first phase,

an in-principle agreement between Ministry of Public Health and Growing the Nations Therapy

Programmes. The next steps will be to finalise the technical details and then submit it for evaluation

by the Secretariat General of the Ministry of Public Health. It may or may not be accepted.

LUTHERAN HOSPITAL AMBOHIBAO Individual occupational therapy services are provided free of charge on a bi-weekly basis, based

on staff availability.

Number of clinic days: 10

Total therapy sessions: 164

Average clients/day: 17

Maximum clients/day: 24

Conditions treated: Cerebral Palsy, Club Feet, Down’s syndrome, Autism, Cleft Palate, Hearing

Impairments, Visual Impairments, Developmental Delay, Foetal Alcohol Syndrome, Congenital

Pseudarthrosis of the Tibia, Intellectual Impairments, Learning Difficulties, Hand Injuries, Epilepsy.

Growing the Nations Therapy Programmes | Bi-Annual Progress Report July 2013 4

July’13

Bi-Annual Progress Report COMMUNITY BASED REHABILITATION: SABOTSY NAMEHANA

We have the privilege of partnering with the

Ministry of Public Health at one of their Community

Based Rehabilitation (CBR) projects in the

communities of Anosy Avaratra and Sabotsy

Namehana. We provide technical support in the

form of training, supervision of CBR agents and

administration, as well as making available supplies

as we have resources at our disposal.

Our joint objective is to develop this project as a

model that can be duplicated in other areas.

Number of residential areas served: 22

Number of CBR agents: 44, divided into 3 teams

Direct supervisors: 2 doctors, 5 physiotherapists

TRAINING

DATE AUDIENCE TOPIC

13/2/13 CBR Agents, Mayor,

Representatives MoE,

MoP, Heads of

Residential Areas,

CBR Supervisors

Philosophy of CBR

19/2/13 CBR Supervisors How to facilitate and

monitor CBR programs

06/03/13 CBR Agents Philosophy of CBR

Identification

Setting goals

27/05/13 CBR Agents

(attendance low)

CBR Supervisors

Stroke Rehabilitation

13/06/13 CBR Agents

CBR Supervisors

Quarterly Meeting

Stroke Rehabilitation

Successes: All CBR agents have identified at least 2

people with disabilities in their communities. All

have engaged in helping at least one person.

Challenges: CBR agents are not paid, and the

motivation depends a lot on the individuals. Some

group leaders are less motivated than others.

Growing the Nations Therapy Programmes | Bi-Annual Progress Report July 2013 5

July’13

Bi-Annual Progress Report SENSORY STIMULATION PROGRAM, IRIS MINISTRIES

Iris Ministries Madagascar takes care of over 60 abandoned children, giving them shelter, food,

education and love. Abandonment and developmental delays often go hand in hand due to a variety of

reasons, including emotional trauma, lack of stimulation, and lack of positive physical contact.

We would like to thank Tatiana, a volunteer who helped us

launch a pilot sensory stimulation program for the 3 – 5

year olds, in the IRIS preschool in March 2013. The success

of the program, including the teacher’s positive view on the

changes in the learning behaviour of the children,

motivated us to employ Angela Beso beginning May to run

the program permanently, 3 times a week. It is based on

the Sensory Stimulation Program developed by South

African Occupational Therapist Annemarie van Jaarsveld.

Number of children in the program: 8

Number of sessions May-July 2013: 30

RESEARCH

We want to follow evidence based practise in the therapeutic programs we administrate and

contribute to the database of published scientific studies that relate to disability and therapy in

Madagascar.

The results of the first narrative study are being analysed. Parents and caregiving grandparents of

children with disabilities in Antananarivo were asked to tell their stories. Common emerging themes

are 1) Late diagnosis of disability, 2) Going to a masseuse as first intervention, 3) Believing local “old

man’s tales” to be the cause of disability, 4) Fatalism, “it is how it is”, 5) Lack of knowledge about the

availability of services and how to access them, and 6) Hope that the disability will go away.

Growing the Nations Therapy Programmes | Bi-Annual Progress Report July 2013 6

July’13

Bi-Annual Progress Report DEVICE AND EQUIPMENT DEVELOPMENT

High importation taxes contribute, amongst others, result in a lack of assistive and therapeutic

devices in the country. Devices are mostly supplied by foreign donations, and to some extend

through government funding. The need far out-weighs the availability. The wealthy have access to

imported devices, as an exorbitant fee compared to the average Malagasy salary. For this reason

we started exploring the making and development of low-cost therapeutic devices that are

affordable to the general public in April this year.

Up until now we have made low cost chairs and standing frames for children with disabilities,

sending home 4 chairs and 2 standing frames. The process of improving the designs is continuous.

The families contribute to the cost of the devices, but often we subsidise most of it, which leaves us

supplying devices at a very slow pace. But one at a time we are making a difference. We also want to

thank Julia Weis who helped us with the illustration of a set of Malagasy language learning cards for

children with speech delays.

“There is always a turning point… The need to manufacture low-cost devices has always

been evident, but put on hold because of the many other needs.

Then someone referred the boy in the above picture to me. He came to Antananarivo to

be hospitalized, because of malnourishment. His mom explained that he vomited every

time after eating, never finishing a plate of food.

Attempting corrective positioning seemed a good starting point, so I propped him up in

an apple box, with which he was quite unhappy. He was sitting upright though, and the

compassionate people at a woodwork shop near my house agreed to turn the apple box

design into a wooden chair within a day. Once seated I taught his mom feeding

techniques and watched as he finished a plate of food for the first time. As I saw her

smile I realised that with a simple chair we have given back to her one of the most

precious roles of motherhood … feeding and nourishing a child.”

Growing the Nations Therapy Programmes | Bi-Annual Progress Report July 2013 7

July’13

Bi-Annual Progress Report MAHAJANGA

Common Ground Church based in Cape Town, is

faithfully involved in the work done in

Madagascar. They sent over various support

teams who come alongside local initiatives.

In July Anri-Louise could accompany the team of 8

South Africans to Mahajanga because of the

church’s generosity. They support the work of Dr

Heuric, at the Lutheran Hospital Mahajanga.

This year’s outreach activities included building

overnight facilities for the families of patients in

the hospital, training of midwives, community

education on basic health and sanitation,

occupational therapy, ministering at church

events and organising and cataloguing a container

of donated medical supplies.

As part of the outreach the team did 148 therapy consultations, both in groups and individually.

These included parent counselling, and workshops. The main focus of the week centred around

cerebral palsy. This is what one of the parents had to say:

“Thank you. We never knew that we as parents are

able to help our children ourselves. Now we know.”

Growing the Nations Therapy Programmes | Bi-Annual Progress Report July 2013 8

July’13

Bi-Annual Progress Report NEW DEVELOPMENTS

We plan to see a few more projects take off over the next few months, making use of therapy

assistants as well as volunteers. Here is a peak into what we have planned.

The EPP Ambonidroa has the only integrated

and inclusive classroom in the specific

municipal area, with 22 learners. The

municipality have asked us to be involved. We

have met with the parents and the teachers,

as well as screened the children. The plan is to

meet early September, and together with the

parents, make teaching devices. We will also

support the teacher with additional training.

CRENAM is a nutritional support program for

malnourished children. Friends of ours who

are part of AMF have a CRENAM program in

the community of Ambohidratrimo. Dealing

with the results of malnourishment reaches

beyond nutrition. We will be involved in this

program, initially once a week, by providing

developmental stimulation activities for the

children who come to eat at the clinic.

The needs of children with learning difficulties

are mostly unmet. During the “summer”

holidays we will run two pilot programs,

exploring the scope of potential future

investment in this much needed area. The one

will target 5 -7 year olds at a local primary

school, the other will target 8 – 11 year olds

that are already enrolled in a holiday program.

For more information, visit our website at www.growingthenationstherapyprogrammes.com

Follow our news events on www.facebook.com/GrowingTheNationsTherapyProgrammes