Assumptions

A conversation I had with a gentleman (waiter at a restaurant) accented an important assumption regarding children experiencing disability and their families in this cultural context. The conversation went like this:

Waiter: What do you do for a living?

Me: I am a therapist.

Waiter: Oh! That is wonderful. So you help people.

Me: I try to. I work with children with conditions such as Autism and Down Syndrome.

Waiter: Oh, yes, orphans.

Me: What?

Waiter: Orphans.

Me: Oh, in Ethiopia, yes, many of the children live in orphanages but in other countries they live with their families.

Waiter: Really? So they can take care of them?

Me: Yes.

Waiter: Families here must learn to take care of these children.

Values

If you haven’t yet read Memory of Snow and of Dust by Breyten Breytenbach and you have any interest in Ethiopia, I strongly encourage you to. The literary structure is similar to Don Quixote in that characters introduce themselves into the novel, and the format shifts between dialogue, plays, poems, and prose, however the subject matter is quite different!

It is difficult to step outside oneself to see how others view you. This novel helps do just that and this is an important skill for an occupational therapist, particularly if you are working with people from a culture not your own. It has important things to say about the value system of Ethiopia from a native and about the Western value system from the perspective of non-Westerners (Ethiopian and South African).

The author states:

Could it not be argued that subsistence economies, when assumed consciously, allow for a dignity based on self-sufficiency, that there can be a transformation of basic realities-with earth materials and native intelligence- without the utopist folly of top heavy and foreign relying superstructures? Could there not be the valorization of non-Western traditions and types of    learning allied to the most modern techniques the north has to offer? Surely they put up examples of modesty, integrity, sincerity? They have shown a suppleness of adaptation to harsh of environmental conditions, they are resilient, they have developed survival methods and yet maintain a thrust toward metamorphosis. (p. 122) 

I shot the photos below on a 30 km poorly maintained dirt road near Bahir Dar, Ethiopia on the way to Blue Nile Falls. There are several communities and a lot of farmland along. To me, these photos illustrate the the harsh environmental conditions, resiliency, and survival methods Breytenbach speaks of. For this alone, the people in these images and their compatriots, deserve all the respect I can fathom.

 Boy with his herd

Man walking on dirt road

 Woman resting under a tree

Something From Nothing

My favorite project in OT school was called "Something From Nothing." Professors gave us a box of assorted junk like a piece of string, a screw, a scrap of cloth, and a knub of a pencil, and our assignment was to make something useful using only the items from the box.

I am embarrassed to admit that I don't remember exactly what I made, but I do remember the inspiration I felt when I saw the box. It gave validation to the quirky ideas I always had for repurposing discarded items. This has become quite a trend lately in the Global North for purposes of ecology and design, and it is a very valuable skill when working in areas with few material resources.

While Ethiopia is rich in human capital, the financial and material resources to obtain specialized adaptive equipment can be beyond reach for most people. The World Bank reports that in 2013 (latest data available at time of this writing) the per capita income in Ethiopia was $505 per year. To give context to this number, here are a few estimates of daily costs:

• Bus rides within the capital city cost $.10-$.20 each way (many people must transfer and take more than 1 bus each way to work)
• Meals in an average restaurant with a soft drink or bottled water cost approximately $3.00
• An out of town round trip bus ticket costs approximately $40.00-$60.00, depending on the distance
• A flight between cities within the country costs approximately $300 round trip
• Cellular phones cost between $20 for a simple phone to around $150 for a (non iPhone) smartphone
• Cellular phone service is prepaid and costs approximately $.04 per minute. (landlines are rare in private homes)

One of the requests we had while working with at a local school for children on the autism spectrum, was for strategies to help them eat more independently. The first child demonstrated a high motivation toward self feeding but decreased hand coordination and strength. Because the standard spoons in Ethiopia tend to have long and thin handles like this:

We decided that a built up handle might do the trick. The challenge was how to obtain one.

One alternative might be to order specialized utensils, such as these available from Good Grips:

for anywhere from around $8.50-$31.00 (plus shipping cost) which would 3%-8% of the average Ethiopian annual salary. Percentage-wise, this would be equivalent to an American spending $1591-$4243 on this spoon. (World Bank reports $53, 042 as 2013 per capita income in the United States) It was not a viable alternative.

A less expensive (but also less durable) alternative might have been to add a piece of foam to the handle of the child's spoon for around $2.00 (plus shipping). This was more affordable, but in this context, still not attainable locally or sustainable (meaning even if we obtained funding, it still wasn't a reasonable alternative because the child would always be dependent on external funding).

Our challenge was to find a material which was locally available for a reasonable price and was durable. I thought the circumference of a garden hose might fit well, so I asked a staff member if they had a hose. It turns out that although they use jerry cans to water their plants, they did have discarded "tubo" (clear plastic tubing) in a pile in the courtyard. After cutting a length, thoroughly washing it, and trying it on the child's spoon, there was only one more problem to solve. The spoon handle was so thin that it slid around and the tube was too wide. We toyed with the idea of taping, plugging it, and stuffing it but decided that those ideas were less hygienic and too labor intensive for daily maintenance/cleaning.

Luckily, in the classroom they had some plastic spoons with thicker handles (which they use for matching with photographs and words in preparation for using the PECs communication system) and the school was kind enough to allow us to use them for this purpose. The (free) result is below:

The 8 year old child learned to self feed within a few minutes, his smile was ear to ear, and the staff are able to duplicate this tool (free) for anyone who needs it in the future.

Occupational therapy education in Ethiopia

I've had preliminary conversations with the dean of a major university in Ethiopia. He stated he wished to continue conversations around establishment of Ethiopia's first occupational therapy education program and that he is proud for his university to be a pioneer in this regard.

Tomorrow, we'll meet to continue our efforts in person. Soon, I'll visit the university to learn about their current course offerings, teaching style, and available resources.

It will be a long road and we'll need many partners along the way. Before developing the coursework itself, we'll have to demonstrate support from stakeholders and supporters including local advocacy groups for people experiencing disabling conditions, other occupational therapists, other rehabilitation professionals, medical professionals, special education professionals, and other people of goodwill. If you'd like to help, please consider  signing this petition to help support the first occupational therapy education program in Ethiopia.

If you have any other information or resources to share, please email me!