Our 2011 service time in Ethiopia has come to a close. After months of fundraising and preparing, we set out to do what we had planned:
- Conduct a needs assessment of some of the transition homes and orphanages in Addis Ababa, and
- Provide appropriate training for the caregivers and medical staff based on the identified needs.
Ethiopia is a country with only a handful of occupational therapists.
And, of these, all travel to Ethiopia from other countries. In fact, occupational therapy is not formally recognized in Ethiopia. Occupational therapy programs at the University level exist in 56 countries. Ethiopia is not one of them. (http://www.wfot.org/schoolLinks.asp)
Physiotherapy (a.k.a. physical therapy) does exist in the country. Still, we noticed a need for more of these practitioners. Our observations were confirmed through discussions with others. Across all our visits, we only met one child being treated by a physiotherapist.
In general, Ethiopia is a country where children and families find it hard to access therapy services either for healthy childhood development and wellness or after disability / developmental delays are identified.
While each of us comes away from this experience feeling like we accomplished our goals, we’re still very much processing our overall experiences. This will surely going on for weeks and months now that we’re home.
One of the major themes we’re immediately processing is our “cultural sensitivity” as individual therapists.
This ideal, commonly referred to as cultural awareness or cultural competence, is an important skill therapists strive to attain. We’re always working and evolving to become more culturally sensitive/competent. Being sensitive to an individual’s background, values, roles, experiences, traditions, and beliefs is absolutely critical to the effectiveness of an occupational therapist. We were prepared to be culturally sensitive practitioners while in Ethiopia, but were taken by how many diverse types of cultures we had to be cognizant of.
Here are a few examples of the various cultures we encountered, as well as particular reflection questions for each:
- What are the important activities for each individual in terms of work and leisure?
- What type of food(s) do they eat, and how do they eat them (hands, utensils)?
- How do they get to work?
- How do they take care of their children?
- Who takes care of the children?
- What are childhood games and activities?
- Is it imposing to bring US toys to them to work on skill development? Is this setting-dependent?
- What does it mean to be an orphan?
- What does it mean to have a disability?
- What are the general feelings and attitudes regarding disability?
- What does HIV/AIDS mean to them?
The HIV/AIDS situation is clearly a dominant issue. Here’s an excerpt from a January 2006 report by Unicef (http://www.unicef.org/infobycountry/ethiopia_30783.html) that clearly summarizes the situation:
“Ethiopia counts one of the largest populations of orphans in the world: 13 percent of children throughout the country are missing one or both parents. This represents an estimated 4.6 million children – 800,000 of whom were orphaned by HIV/AIDS.”
Operating in a city (Addis Ababa) vs. village setting
- How do these differ?
- How do children and adults spend time during the day in the villages?
- How do they spend their time in the city?
- Do children go to school? How are the villages different?
- How many children from the villages have ever seen a car, a tall building, etc?
- What does play look like in the villages, compared to in the city?
The orphanage culture
- What are others’ feelings towards orphanages in the community and the staff that work there?
- How do children get to orphanages?
- How long will they stay?
- What experiences do they bring?
- What is the education/training of the nannies? What is the ratio of children to nanny?
- How can we make recommendations to nannies while still respecting how many children are in their care at once?
- How do they feel about their jobs?
- What is the hierarchy of the staff?
The adoption culture
- understanding the process of adoption, hearing the stories of families adopting, seeing families united as one for the first time, understanding our own feelings about adoption, understanding the language used with adoption
In expectation of encountering all these various cultural settings, we also used this trip as the first part of a pilot research study. We utilized a research measurement tool (survey) to measure our individual levels of “cultural competency” pre- and post-trip. This pilot study will help us begin to understand the needs of therapists and the service program. I hope we’ll see interesting results from use of the standardized test, knowing it is only a pilot study. The plan is to use this data to help us develop a cultural awareness curriculum for all therapists going on future Embrace service trips.
Next steps for Embrace (in reference to the Ethiopia service trip):
Our plans are to present our needs assessment findings to the adoption agency, to our local communities, and to our colleagues. It is important we share and learn from one another so that we (therapists and health practitioners) can provide quality education and support to countries and settings in need.
While the 2011 Ethiopia Service Trip is coming to a close this is just the beginning...
Thanks again for joining our journey. We appreciate your ongoing support and hope that you will share this with others that may find it interesting. Embrace has so much for the near future that we would love to share with you. Below are a few ways to easily stay up to date with Embrace:
Last but not least... we have some great videos that are currently being processed and will start posting them on Monday June 16th 2011. We're working to get our youtube site up and running :)
Angie, Brandi, & Jackie