Kirrily Manning’s work developing Occupational Therapy in Ukraine
Throughout the years that Go Global, Ukraine ran at Curtin University (2009-2013), over 70 students from occupational therapy, speech therapy, physiotherapy and nutrition travelled to Ukraine to participate in the objectives of the program.(NB Go Global is an international practicum placement program that still operates, however not in Ukraine). The key focus of this program was to up-skill orphanage care staff in babies homes (0-5 years) to with disabilities so that every day care practices could become more therapeutic in nature.
- Ukrainian Women’s League donated food for the poor
- Fake Christians
- Zeleni Sviata – Building Ukraine Together
Following an extensive Needs Analysis, a community based rehabilitation approach was utilised by two teams that travelled each year which resulted in significant advancement for the staff, not only of the technical aspects of feeding, play, positioning and sensory integration but more importantly in how staff relate to, and value, the children.
Teams typically had 6-10 students with one supervisor, led by Occupational Therapist, Kirrily Manning. Teams would establish relationship with an orphanage, spend up to 2 years training staff and local community volunteers in therapeutic care practices and then move to another orphanage. By training local volunteers, correct care practices were reinforced and encouraged once teams returned to Australia. In addition, Go Global established relationships with local parent support groups, providing train the trainer skills for parents who have made the difficult decision to keep their children with disabilities at home.
Integral to the success of the program has been liaising and working with universities and rehabilitation facilities, running workshops, information sharing and discussing care practices for people with disabilities. Teams worked in Kyiv, Odessa, Novograd Volynski, Lviv and Kharkiv.
The Go Global Ukraine program at Curtin was suspended in 2014 because of the war in Ukraine and the MH17 tragedy. Kirrily Manning continued to work on a voluntary basis with established partners, taking Alumni of the program to work in a voluntary capacity https://developmenttogether.com/location/ukraine/, to continue the project work started. This has included ongoing training, writing of university curriculm for Lviv Polytechnic University and working with World Federation of Occupational Therapists (WFOT) to introduce the first occupational course to potential trainings at Lviv Catholic University in 2018.
Changes in care practices and results for children
Over just a few months incredible changes happened to the children physically, emotionally and socially when staff learnt how, and took the time to, position children appropriately. Children with muscle tone problems need a 24 hour positioning regime to prevent secondary disabilities such as contractures. This also enabled them to feed, play and sleep comfortably. Many children in orphanages are just ‘left’ for long periods, with staff believing these deformities are simply natural progressions of the disease, rather than completely preventable secondary issues. It is not uncommon to see kids positioned as per the photos below:
Dimer is actually 7 years old. His high tone has resulted in permanent hyper extension of his spine and dysfunctional upper and lower limb positions. Positioning him well is not hard, carers just need to know how to reduce his muscle tone and keep him positioned well so the right messages are being sent to his brain.
When Kirrily first started at one orphanage, young Bohdan was left all day in a cot in the babies room because carers kept saying he would die soon. Bohdan’s “frogged legged” position means he cannot lie or sit comfortably, see the world around him or bring his hands to the midline to engage in activities we take for granted. Teaching carers a variety of positions throughout the day, is critical to good development and prevention of secondary problems. He is so much happier when positioned well and is still alive some 4 years later!
Carers were taught that every day activities such as dressing and feeding can be fun and therapeutic, and there are lots of thing these kids can do if given the opportunity. Overall, children where the training has been run (a 3 day training package) have shown improvements in feeding and nutrition, motor function, play engagement, social and psychological health and sensory integration. The techniques in the training package are not complex and are easily learnt, practiced and taught by non professionals. Carers are taught that every day activities such as dressing and feeding can be fun and therapeutic. And that there are lots of thing these kids can do if given the opportunity!
Ukraine is moving into an exciting new phase of wanting to establish occupational therapy from within. Following the WFOT course in 2018, they have established a Ukrainian Occupational Therapy Society, are writing curriculum for several university courses and are wanting to upskill existing rehabilitation staff in occupation based therapeutic techniques.
Through support of the AFUO’s Ukrainian Crisis Аppeal, we are hoping to raise funds to provide an 8 week course in 2020 to provide much needed occupation based rehabilitation skills so that people with disabilities in Ukraine do not have to wait years for the professional to establish itself before they receive high quality, evidence based rehabilitation. The course covers several areas of practice including physical rehabilitation, neurological intervention, paediatrics and mental health. It will provide a scaffolding approach successfully piloted in Vietnam with over 100 health practitioners and is ready to roll out in Ukraine, with a key component being the training of trainers so that dependence on external, international assistance will be avoided. It is proposed that 40 rehabilitation professionals will participate full time in the course from at least 20 institutions. (Four weeks online and 4 weeks in person classes over the summer). This will be followed by an additional 40 in 2021 trained by the 2 trainers identified during course one and mentored for an additional 12 months. Each of these 80 professionals treat 6- 8 patients per day i.e. up to approximately 1600 patients per week. The total cost of the course and additional 12 months ‘train the trainer’ is just over $100 000, which means that each therapy session provided by course participants is just 70cents!
Kirrily’s work has been supported by Bohdan Mykytiuk from the Ukrainian since 2007, by facilitating contacts with Dzherelo Centre for people with special needs, Lviv Politechnical University, the Ukrainian Catholic University School of Rehabiliation Medicine, the Occupational Therapy Association in Ukraine, The Honorable Ms Ulana Suprun, Health Minister in Ukraine, and Stefan Romaniw, Head of the Australian Federation of Ukrainian Organisations (AFUO). At the AFUO conference in June 2019, developing OT in Ukraine became part of AFUO’s Ukrainian Crisis Appeal.
AFUO hopes generous people will partner with Kirrily to bring much needed, effective rehabilitation practices to Ukraine. You can donate directly through Ukrainian Crisis Аppeal website.
This post is also available in: Ukrainian