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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
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