Farewell for now, Samuha

We finished the placement and our time at Samuha in Southern India at the beginning of February and after having some time to reflect on our 5 weeks there I’d like share a little bit about our experience.

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Chalk painting outside of Samuha on Republic Day
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Chalk painting outside of Samuha on Republic Day

The goal of our time at Samuha was to educate local Community Based Rehabilitation (CBR) workers to enhance their skills, while at the same time providing a once in a lifetime learning opportunity for the 4 UBC students. Based on the final meeting with all of the Samuha staff and individual meetings with students I am pleased to say that the project was a huge success!!

Ayalappa and Prabhakar teaching at one of the training days
Ayalappa and Prabhakar teaching at one of the training days

During the final meeting, staff were very thankful for the education that was provided to them. Especially the educational sessions where we covered paediatric assessment and treatment, wound care, stroke rehabilitation, surgeries available for children with cerebral palsy, and hip dysplagia. We tried to keep the sessions as interactive as possible and I will make sure to remember this in future teaching sessions that I do.

Josina teaching CBR workers at one of the training days
Josina teaching CBR workers at one of the training days
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Madison and Krysta assessing a child with muscular dystrophy at the Spinal Cord Rehabilitation Centre

As far as suggestions for the future, the staff wanted us there longer and to focus solely on education! I love these suggestions and totally agree that a longer time commitment would be great in order to really focus on their needs and goals and have enough time to go through theory and practical sessions with CBR workers. Lucky for them they have an awesome Physiotherapist, Andrea Mendoza (www.physioandrea.com) going for 6 months next year!!

Krysta teaching at one of the training days
Krysta teaching at one of the training days
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Sara teaching CBR workers at one of the training days

Now, let me talk about the 4 amazing students that I had the pleasure of teaching for 5 weeks! To be honest, I was a little nervous as a relatively new physiotherapist taking 4 students for my first time as a clinical instructor. But, I couldn’t have asked for 4 better students. The teamwork they displayed was incredible! Since there were 4 of them and 1 of me there were of course times when I wasn’t available to all of them. But, they were great at working together and often times solving problems as a group. At the end of the placement, I was happy to let them know that in my mind they were already physiotherapists. Canada is lucky to have such intelligent, caring, and motivated people soon to be part of their healthcare system.

The girls wearing their Saris and me wearing a Dhoti. (Right after we were on Indian TV)
The girls wearing their Saris and me wearing a Dhoti. (Right after we were on Indian TV)

One aspect of the placement that everyone seemed to really like was our nightly recaps. With these daily recaps we had a chance to talk about any clients that we saw throughout the day and talk over assessment, treatment progression, or any other questions that came up. I think the highlight of our nightly chats for me was the highs and lows. This is where the students and I would each go around saying our high and low for the day. As an example, one day my low was seeing the state of a public school where a child who had very low mobility and a severe pressure sore was placed in a classroom on the second floor where he sat on the floor in his own urine. The high for that day was seeing how all of his friends helped him get home. They would help him manage the very steep set of stairs, where they had a pink bike waiting at the bottom. The child would then get himself on the bike and his friends would wheel him home. Just an incredible sight! This is just one example of many to show how caring and helpful Indians truly are. Even at a young age, there was no judgement for this little boy. Only, friends more than happy to help.

The incredible spread at Mutthana (orthotic technician) and Karmalla's (orthotic assistant) house
The incredible spread at Mutthana (orthotic technician) and Karmalla’s (orthotic assistant) house
Eating our delicious homemade Dosas at Prabhakar's house
Eating our delicious homemade Dosas at Prabhakar’s house

Similarly, the people who are involved with Samuha are all in it for their love and desire to help people with a disability. The staff at Samuha work tirelessly to help people in their community and are changing the world as they do it. They work 6 (often 7) days a week and as many hours during the day that is needed to make sure that every child, person, and family member is seen to the best of their ability. Many of the staff even welcomed us into their homes and really made our time at Samuha the best experience possible! I am happy to have had the chance to meet such incredible people and look forward to planning a return trip where hopefully I will be able to contribute in a larger way. Phil

UBC Students’ 2nd Post: The Spinal Cord Injury Rehabilitation Centre

Two years ago, Samuha’s Spinal Rehabilitation Centre (SRC) was opened a short distance away from the Early Intervention Centre campus. It is the only rehabilitation centre of it’s kind in the entire state of Karnataka. It is currently equipped to support 6 residential Spinal Cord Injured (SCI) clients for 3 month stays each. Samuha is in the process of expanding the centre to have the capacity to host 16 SCI patients at a time. The SRC is unique in its ability to host clients long term and provide effective rehabilitation throughout their stay.

Exercise area at Samuha's Spinal Cord Injury Rehabilitation Centre (SRC) with specialized training equipment for wheelchair access, stoke rehab, and other neurological conditions.
Exercise area at Samuha’s Spinal Rehabilitation Centre (SRC) with specialized training equipment for wheelchair access, stoke rehab, and other neurological conditions.

Following a spinal cord injury in India, most people will spend some time in the hospital, where they may or may not receive physiotherapy treatment. Once they are discharged from the hospital, they return home, sometimes to villages hundreds of kilometers from the nearest hospital. Depending on their financial situation and mobility level, they may or may not be able to transport themselves to see a doctor for follow-up visits. Unfortunately this means that many of them end up spending much of their time lying in bed, without any mobility aids such as wheelchairs to get around in. When asked about this, the head Community Based Rehabilitation (CBR) worker at the SRC, Ayallappa, expressed concern that these patients spend most of their time sleeping and depressed in bed. What often happens when SCI clients are not well educated on their condition and do not receive the support the need, is that they end up spending too much time in certain positions and develop pressure sores. Without the proper attention, these pressure sores will worsen and likely become infected, leading to a very poor outcome.

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Parallel bars and outside exercise area at Samuha’s Spinal Rehabilitation Centre

When clients are admitted to the SRC for their 3-month stay, they are provided with a rural wheelchair (3 wheeler chair for rough terrain), a bed and 3 square meals a day. They are also able to use all the facilities on site, which include, a rehabilitation gym, accessible bathrooms, accessible laundry facilities, gardens and a learning hall. They are cared for by staff on site and are rehabilitated in the gym by CBR workers during the day. Many of them come to the SRC with pressure sores and the staff diligently clean and dress them to allow them to heal. They also often have to learn to sit independently, transfer in and out of bed into their new wheelchair and complete all the strengthening and stretching exercises they are given by Ayallappa. Over the course of their stay they become independent in their mobility and develop really strong upper bodies!

A physician from Koppal has started volunteering his time to come to the SRC every 15 days to ensure the patients are medically stable and provide them with any medications or treatment they require. He has also started teaching the CBR workers how to properly care for the pressure sores and how to monitor for signs and symptoms that might require medical attention. He is also able to provide them with professional consultation on equipment they may benefit from.

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Two of the clients at Samuha’s Spinal Rehabilitation Centre (SRC) enjoying volleyball!!

Now that you know about all the wonderful things happening at the SRC, could you imagine if they were able to address some of the missing pieces? Firstly, if they had air or water mattresses to sleep on, their incidence of pressure sores would decrease (according to the physician) by 50%. Secondly, if they were able to provide waterproof and more durable cushions for the wheelchairs this would help with longevity of the cushion and also to decrease the incident of pressure sores. Thirdly, the supplier that they get the specialized rural wheelchairs from has stopped providing those wheelchairs. Samuha is now unsure how they will be able to purchase these chairs to provide to their clients. If you know of a good supplier, please contact Phil. Lastly, since it is the only centre of it’s kind in the state, they are not able to accommodate even close to the number of people that could benefit from a stay here. Samuha has been cautious about spreading the word about SRC, because they know the demand will be so high and they won’t have the resources to provide a high quality of care to all those who could benefit. It’s unfortunate to know that some people may be stuck inside because they haven’t received the care they need post discharge from hospital. They are currently in the process of expanding, but this will only add 10 beds. So many more would benefit from this amazing centre!

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Sara and her friends at the SRC enjoying a great core and sitting balance exercise class!!

During the day, we have started running group exercise classes to keep everyone engaged and they have really enjoyed being able to play their own music through our mini portable speaker. The guys also love when we get a group volleyball game going outside and you can tell the social aspect of the SRC is extremely beneficial. When asked by a prospective patient’s wife whether or not her husband should become a resident, all of the current residents raved about their experience at the SRC and how much strength, mobility and independence they have gained. We all look forward to our days spent at the SRC because the atmosphere is calm, laid back and friendly. Samuha has definitely created a great atmosphere for recovery and we’re so grateful to play a role in it.

– Krysta, Josina, Sara, & Madison (UBC Physiotherapy Candidates)