Occupational therapy in Ukraine--Susan K. Meyers

This is from a new web site for the organization I went to Ukraine with.

Vira Kushnir in 2005

This project began in the fall of 2004 when I joined a local voluntoursim group on a trip to Ukraine to work with orphans. The critical moment in this trip was meeting Vira Kushnir, a translator who was trying to develop services for children with disabilities in her community. I asked Vira: “If I bring OT students will you make arrangements for us to provide services to the children in your community?” With this encounter, the relationship between occupational therapists and Vira began.

Vira and I began our plans and in 2005, a group of six students completing their first year of occupational therapy school joined me and a doctoral student in the first trip to Chernivtsi, Ukraine. Our group arrived in Kiev and traveled on to Chernivtsi. Vira had arranged a meeting with parents and other caregivers of disabled children in collaboration with the local social service agency and this was our first opportunity to introduce OT to the community. We subsequently made home visits for each child whose parents requested occupational therapy. This first trip we saw six significantly disabled children in their homes each day for a week and the caregivers spread the word that occupational therapy was a good thing.

On this first trip we learned much about the limitations for persons with disabilities in Ukraine. If a child could not walk and talk, that child is ineligible to attend school. Most families we visited lived in accommodations that are inaccessible; often a child lived out her entire life on a bed in the family’s only room. We also learned the value of love in sustaining children with severe disabilities without medical care that we take for granted. The children we saw had none of the physical side effects of immobilization or inability to effectively take nutrition by mouth that we would see in the United States.

Our objective the first year was to earn the trust of our hosts, and to try to provide the care they wanted. Although, caregivers hoped we could cure their children with medicine or therapy, we explained that this was not our work, occupational therapists help persons acquire skills for the job of living and we would help them achieve a desired goal toward self care. The first year we saw adolescents who wanted some independence in activities of daily living including personal hygiene, dressing and for one young person, using a notebook computer, which had been donated to our group. By the time we left Chernivtsi in 2005, this young man had come to realize that even though he could not leave his home; he could use his computer, improve his English skills and provide translation service as a means of support in adulthood. This was occupational therapy at its best: personal, practical and inspirational to therapist, client and community.

After our success in May 2005, we began planning our 2006 trip to Chernivtsi. While we prepared in the United States, Vira was busy in her community. She chartered Aquila, an international charity, in Ukraine to help meet the needs of children with disabilities in her community. Her first activity was to gather all the mothers who cared for the children we saw in 2005 to form a support group which met monthly and also provided activities for the children. These children who had been confined to home began to participate in music, crafts and other activities of childhood with the assistance of local volunteers while many of their mothers learned for the first time that they were not alone in caring for a disabled child.

May 2006, there were three groups of occupational therapists and students as well as a speech therapist, twenty-one people on a mission to improve the quality of life for children and adults in Chernivtsi. One student from the first trip chose to complete half of a required internship in a psychiatric hospital in Chernivtsi by establishing a program to offer activities to chronic and severely mentally ill persons of all ages. The rest of the travelers in 2006 continued the practice of the previous year by teaming an occupational therapist with OT students for home visits to children. However in 2006, one of our goals was provide services to people of different ages and disabilities so we also saw home bound adults with disabilities and began our work as teachers to Ukrainian caregivers. We taught social service providers how to more safely manage their home bound patients, we spent a day in a long term care facility teaching nurses how to safely move patients without causing pain or injury to patient or caregiver. Each participant in 2006 came home with new appreciation for our life in America, but also with a fresh perspective on understanding culture and environment as essential components to our caring for others. In 2006, our therapists provided care to over 150 persons with disabilities living in Chernivtsi.

One special event that occurred in 2006 was an encounter between, Tim, an occupational therapy student and Kostia, a young man with paraplegia as a result of an injury in the service of his country. Tim and Kostia were close in age and interests. Kostia wanted to have some independence from the total care his mother provided him. We arranged for Tim to bring a notebook computer to Kostia so that he could connect with his “buddies” via the internet. Tim’s job was to make this happen even though Kostia has no use of his arms or hands. Over the week in Chernivtsi, Tim worked with Kostia to turn a Washington Red Skins baseball cap into a device that allowed Kostia to turn pages of a newspaper and type on the computer we adapted for his use. In addition, Tim devised a system that allowed Kostia to drink a beverage without assistance. The local television reporter and cameraman were present when the computer was given to Kostia and he independently engaged in its use, there wasn’t a dry eye in the house.

The focus of our work in Ukraine began to shift from direct service to education. In 2007, two groups of students and therapists, each spent 10 days in Ukraine. Although our time in Ukraine is limited, Vira and her group of mothers, their children and volunteers continue our work in our absence. Summer camp for children with disabilities provides an opportunity for families to spend time together in the country laughing, playing and being inspired by each other. Vira envisions the possibilities of a school/rehabilitation center for children with disabilities as well as a hippotherapy program that provides recreation and therapy. She works with social service agencies and local officials to try to identify needs and resources for persons with disabilities.

In 2007, four students and ten therapists provided occupational therapy in homes, institutions for children and adults, and taught rehabilitation techniques to doctors and other care givers. As in pervious years, we visited city hall for official meetings and were followed almost daily by the local television and press. As a result of television segments about our work, people of Chernivtsi asked for our help as we rode the bus or walked to visit clients. We taught local craftsmen to make adaptive equipment modeled after equipment commercially available in most of the developed world. Our goal shifted to education and rehabilitation that could be sustainable.

In 2008, students from three universities and faculty from seven universities provided nine lectures about occupational therapy to physicians and other care givers during two trips to Chernivtsi. We continued our tradition of community care to children and adults with disabilities. Future collaborations for teaching and service were established with the children’s hospital, a long term care and rehabilitation facility, and oncology and orthopedic hospitals. We observed ongoing construction and renovation of hospital facilities and new equipment which has led to improved health care. Each year, our collaborations with physicians and other health care providers becomes more focused and directed toward eventual establishment of occupational therapy in Ukraine.

In the 4 years we have visited Ukraine we have vicariously experienced democratic elections which hopefully will lead to continued improvement in living conditions and health care for Ukrainians. However, we also have seen the painful growth of a democratic society in which there is considerable economic hardship. Each trip we visit orphanages, one for children with life-long severe disabilities and another filled with children whose parents cannot care for them. We bring sports equipment and other recreational games to these orphanages, but also have an opportunity to engage in play with the children and for some of the most disabled children just to hold them and share a moment of caring.

Our trips to Ukraine are eleven days long. We spend seven days in Chernivtsi providing occupational therapy services and a weekend in Kiev learning the history of a country long engaged in being passed from one country to another as a result of war and tragedy. Our travelers are moved by the mass graves of victims of the Second World War as well as the museum erected during the soviet era to honor Ukrainian’s service in this war. Many of our students have grandfathers or even great grandfathers who served as allies of Ukrainian soldiers in that war and are touched by these experiences. We also visit the Chernobyl museum. During our first trip to Ukraine, one student asked Vira “why do the people of your country look so sad all the time?” After the visit to Kiev, they understand the answer to this question. Of course students also enjoy the beautiful aspects of the Ukrainian culture: food, ballet, opera, and arts and crafts.

Our work continues, now through RESOURCE Foundation. Each person who goes to Ukraine pays for her or his own trip. Our work involves many therapists who return year after year. Students, faculty and therapists from throughout the United States representing different racial, nationality and religious groups collaborate in providing occupational therapy to Ukrainians. While this may set us apart from others who provide mission services to Ukraine, it is reflective of our professional belief in social justice and the benefits of a multicultural society.