Giving Special Children Special Care: Geutanyoe’s Mobile Paediatric Physiotherapy Clinic

 

“My career began in a sheltered environment – a hospital in Singapore where I can have all my equipment and training. It was an environment that wasn’t too challenged but was filled with great demands. When I went to study overseas, I was exposed to learning on children in difficult circumstances – about refugees and poor village children. It truly would have put my skills to shame if I knew about this but wasn’t doing anything about it. It was to me an obligation and responsibility to reach out to these kids to assist them where I can. So, I left the hospital scene, and decided to embark on a journey, following my humanitarian passion to volunteer for Yayasan Geutanyoë (YG) in Aceh.

Initially, my main aim as a volunteer of YG was to work with the Rohingya refugee population. However, after getting to know the locals, I heard about a couple of children who were physically challenged but did not have the opportunity to undergo rehabilitation. I had read a couple of reports online regarding lack of medical specialist in Langsa town itself. After the team organised meeting with the healthcare workers from Puskesmas Langsa Barat, I was more determined to reach out to the children who are in need and families who require assistance in managing these children.

Rehabilitation takes a long time. It isn’t like medication that can help recovery over a few days. Sometimes the concept of rehabilitation is misunderstood whereby families think that therapies can perform miracles. For an outsider to deliver such services, there needs to be trust and collaboration between both the local medical staffs and the providers.

Currently, I have covered up to five village areas with an increasing number of patients. So far, I am very pleased with the comments and feedback from the families and Bidan Desa (village nurse/ midwife). I do feel that there is a need for the service to continue to bridge the gap of rehabilitative and neuro-developmental needs for the patients I see. When the time comes, there needs to be a transition of care from myself to a local or the Bidan Desa who will continue these services. This will be something I will work towards in the long-term. “


Siti Durriah, Physiotherapist


 

Introduction

The goal of Physiotherapy is to improve the function and independence of individuals treated. In particular, for individuals with limited mobility, Physiotherapy is focused on improving their quality of life by minimizing pain, and maximizing their abilities.

In Paediatric Physiotherapy,  the therapist plays an important role in the physical development of children with delayed motor milestones, congenital deformities neurological conditions, or syndromes that affect physical growth.

Disabilities affect hundreds of millions of families living in developing countries. Approximately 10 per cent of the world’s population lives with some form of disability, 80 per cent of which, according to the United Nations Development Program (UNDP), live in developing countries. There is a projected increase in children with disabilities in developing countries due to malnutrition, infection-related diseases from poor sanitation, diseases and other causes. Often, these areas lack medical attention or healthcare providers, and suffer from a paucity of rehabilitative care.

Poverty and disability put individuals at high risk and greatest disadvantage. The disabled poor, especially in developing countries, tend to not only be disregarded by society, but are also more likely to become victims of rape or abuse, and are less likely to obtain preventative care or legal protection.

Consequently, it is of greatest imperative that we provide therapy to the children who fall into the above category, as well as their families. For infants, intervening early may allow for better development for them, as well as provide the family with strategies to cope with and manage their condition. Physiotherapists will attempt their best to achieve freedom of mobility or increase the quality of life for disabled children, starting as early as possible.

 

Patients in Langsa

In Langsa, the nurse clinicians called Bidan desa are in charge of managing paediatric and women patients in the village area. Bidan desa are skilled enough to perform normal or assisted deliveries, as well as manage simple neonatal cases. They can also prescribe medications or vaccinations for children. Every cluster within each village is covered by a Community Medical Centre, or Puskesmas, which is intermediate to a local hospital. Currently, our services are being catered to the patient population from Puskesmas Langsa Barat, which serves approximately eight clusters of village residents.

There have been multiple failed attempts to recruit patients for consultation at the clinic in the office at Puskesmas Langsa Barat, mainly due to inaccessibility and lack of transport for patients.

As a result, our current arrangements involve the physiotherapist and a staff member, accompanied by the Bidan desa to perform home visits for new or follow-up patients.

 

Case Study 1 – Patient A
One of the cases we have attended to is a premature baby with low birth weight, who required a developmental assessment. Born at 28 weeks, Baby A weighed less than only 2 kg. At her current corrected age of 5 months, Baby A is seen to have normal developmental milestones and reflexes; however, she has a slight increase in the tone of her lower legs, as well as tight calf muscles – which her parents could not identify. Her parents expressed that they had seen their daughter walking on tiptoes, but did not know what to do to correct this.

With just a couple of stretches performed during the session, her parents were able to observe a reduction in tiptoeing. Home exercise interventions were also taught to her parents, for them to continue managing Baby A’s condition until the next follow-up with the therapist.

 

Case Study 2 – Patient B
Another patient we have treated suffers from hydrocephalus. Patient B is 3-year old boy, diagnosed at birth with hydrocephalus, and has undergone multiple neurosurgery procedures. He goes to the public hospital to attend physiotherapy sessions twice a week, but was still unable to produce any movement independently. Patient B is also fretful and cries when any kind of exercise is performed with him.

After assessing the child, the therapist was able to discern that Patient B was unable to bear weight on his lower limbs due to difficulties in straightening them. This prevented him from standing, which is an important posture for all individuals, to keep the lower limb bones strong, and assist with hip joint congruence.

Currently, Patient B needs a pair of braces called “knee gaiters”, to allow him to place his feet on the floor for weight-bearing activities by keeping his knees straight. His mother was taught exercises to mobilise the hip joint, and the therapist will organize a pair of knee gaiters to be given to the parents for use at home.

 

Clinic Objectives

  1. To provide physiotherapy services and developmental care for children under the care of Puskesmas Langsa Barat
  2. To provide the equipment needed for the management of the children
  3. To impart knowledge of developmental milestones and case background to the Bidan desa
  4. To collaborate with the local medical team for co-management of physiotherapy cases

 

Clinic Plan

In the short run, the team is focused on establishing a good working relationship with the local Bidan desa, as well as fostering the trust of the parents and patients in the therapist. The team will continue performing home visits until we are able to transition patients to the clinic premises.

In the long run, our team is excited to be able to train nurses to identify needs and prescribe exercises.

Our team will also continue to work closely with the local medical community for future referrals to physiotherapy.


* Note: This initiative is funded entirely by personal donations. Geutanyoë Foundation welcomes donations of any amount for this critical and historic initiative.

 

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We are dedicated to cultivating and upholding values of humanity, dignity, peace and sustainability in Aceh and Southeast Asia.

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