Therapy Services for 80 Cambodian Families

Community-based rehabilitation is a strategy which has been used for decades in lower-resourced countries such as Cambodia. Over that time it has evolved and broadened to include more than medical rehabilitation, though that is still a relevant need. According to the WHO, "Community-based rehabilitation (CBR) is community action to ensure that people with disabilities have the same rights and opportunities as all other community members. This includes, for example, equal access to health care, education, skills training, employment, family life, social mobility and political empowerment." (WHO, 2004). In places like Cambodia, many people do not have access to professional health and rehabilitation services, It was for this reason that the ABLE Project was started. In order for family-based care to be inclusive of children with disabilities, there have to be support services that address the unique needs of those children and their families. Since these services were not present where our families were, we knew we needed to include our own form of CBR. While the ABLE Project has two Cambodian physiotherapists on staff, we also have staff members that we call Community Rehabilitation Team (CRT) members. These staff are trained on the job by our physiotherapists and an expat technical advisor to provide basic rehabilitation support and follow up. While our physiotherapists are based in Phnom Penh, the capitol city, these CRT staff live in the rural communities in which they work. 

This multi-skilled, uncentralized approach had been advantageous since the start of the ABLE Project, but the current Covid situation has made it even more necessary. While the Cambodian government and people work hard to implement strategies to contain the virus and minimize its consequences, travel from one place to another has been limited and we are all doing our best to decrease the spread of the virus. As there is still no end in sight for a return to "normal," however, the risks have to be weighed against the cost of total isolation. While it was possible and necessary during the biggest surge of the virus to limit our contacts to phone check-ins with the children and their families, we have carefully returned to doing direct visits. Research has shown that time is of the essence when working with children who have disabiliites or developmental delays and the earlier a child receives help the better. We don't really have time to "wait it out" if there are ways that we can minimize risk while still providing the support services these children need. Again, this is where our community-based staff are so vital. 

As an example, in the picture you can see Savorn, one of our CRT staff working on language skills with a little girl with speech and language delays. Using good hygiene and masks and trying to maintain a safe distance, she is able to model for the family how to promote this little girl's language development. Consequently, this child has shown significant improvement and the family is really happy. This little girl and her sister also have a chronic health need for which the ABLE Project has been supporting the family to receive treatment. "Before it was difficult to understand Sophea* when she spoke. Now she is speaking more clearly and saying more words. Both of my grandchildren have become healthier thanks to the appropropriate medical treatment and the care and guidance from the CIF staff. I am happy to see them in better condition than I could have imagined," said the girls' grandmother. 

We are so thankful for your continued support which allows us to continue to ensure that, even in the midst of a worldwide pandemic, children like Sophea and her sister are not being left behind. We hope that you are all keeping safe and finding your way to a healthy balance in this crazy time. 

* Name changed to protect the child's identity.

That's our current take on the phrase "deperate times call for desperate measures." We wouldn't say that things are desperate right now, but they certainly are still quite different from before Covid-19, and the situation can change a lot from day to day. Here in Cambodia the spread of the Covid-19 virus has, unfortunately, become more prevalent. While we had been fortunate to have minimal community spread throughout the first year of the pandemic, things took a dramatic turn in February of this year. We had been using precautions like the rest of the world, even when the virus wasn't doing its worst, but once the virus really started taking off, the Cambodian government took some strong actions to try to reign it in. This took the form of temporary lockdowns where travel was extremely limited within the capital city of Phnom Penh and a few other hot spots, and from one part of the county to another. 

This was a problem for us in several ways. For one thing, there are children in the ABLE Project who live in the provinces but travel into Phnom Penh periodically for reassessment of their conditions and to have their medicines refilled. Children with epilepsy are one of the primary groups to whom this applies. It is essential that those children receive their medications and the lockdowns came without much notice, so we had to do some quick coordination to ensure that they were covered. Fortunately, we were able to work out a plan with the hospital where they receive their assessments and medications. The children received virtual assessments facilitated by our province staff where the doctors at the hospital were able to interview the families and view the children via video calls from our staff. Then we were able to find a transport service which was authorized to travel through the checkpoints so that the medicines could be sent from the hospital to where the children lived. Yay! Problem solved. 

Another challenge was supporting our province staff in using a new assessment tool. We had just transitioned to using this tool prior to the pandemic and, under normal circumstances, our physiotherapists from Phnom Penh would have been doing in person training and coaching to help our provincial community rehabilitation staff become more familiar and proficient with the tool. Since we've been able to do very little traveling between the provinces and Phnom Penh, we adopted the same strategy as we used for our children who needed virtual visits with the hospital. We've begun to use video calls to coach our staff through the assessments. It is not the same as being there in person, but we are making it work and it's helping us to stay on top of things despite the current limitations. In the provinces, where there has not been as much transmission, our staff are still able to make face-to-face visits with appropriate protective gear. For our clients in Phnom Penh we still have to do visits virtually until the number of new Covid-19 cases flattens out. 

Thank you so much for hanging with us through the challenges of Covid-19. We know that the pandemic has been hard on many people, including financially, and we really appreciate those who have continued to financially support this work. Understandably, some donors have not been able to continue their support, so, if you have not given recently and are able to help make up the difference, we would be so very grateful!

Some Good News

We’re so happy about the progress that has been made in the worldwide Covid-19 situation. Though, we realize that we are “not out of the woods yet” and that the virus is still making life very difficult for many, the development of vaccines and the decreased strain on the health care systems that many are reporting offer a glimmer of hope. We hope that the availability of effective vaccines to all people in all parts of the world happens as efficiently as possible so that you all can begin to have some relief, wherever this finds you. As for us here in Cambodia, the situation has remained pretty stable with regard to virus transmission. Though the economic impacts have been severe, the projections are not quite as dire as they had been previously. It appears that recovery is happening, though there is still a long way to go. Even before Covid-19 hit, many Cambodian families lived only one crisis away from being able to sustain their livelihood, creating great vulnerability for their children. So, whether or not Covid-19 remains a threat, Children In Families will continue our work in strengthening families and improving their resilience.

Another bit of good news – last report we mentioned that we had a challenge in finding a stable source of medication for a child with cystic fibrosis. We are happy to report that we are now able to get it on a regular basis from a local pharmacy once again!

Continuing in the “New Normal”

Despite the stability of the Covid-19 situation in Cambodia, efforts remain strong to keep it that way with many people continuing to wear masks and practice social distancing as much as possible. The ABLE staff members are conscientious in their observance of these protective measures. Of course, frequent hand washing is also a must, but ABLE Project staff strive to do that at all times when providing therapy services. The ABLE team has resumed pretty much a pre-Covid schedule while making these necessary accommodations. Over the past three months they have provided over 400 face-to-face visits, most of them at the families’ homes, but also providing some visits in hospitals, health clinics, or schools, depending on the needs of the children and their families. While providing therapy is one of our primary activities, advocacy is also important, whether it involves helping a child with disabilities to be included in public school or ensuring that children with disabilities get the medical care they need and that their families understand clearly about their health status and medical care. Through CIF’s advocacy and support, one child with partial paralysis in her legs has just started school this year and she couldn’t be more excited!

Once again, we want to thank all of you for your support of the work of the ABLE Project. Your giving allows essential services to continue for these vulnerable children and their families.

Disruptive Virus

Well, as you know, Covid-19 continues to wreak havoc throughout the world. We hope that this update finds you and your family safe and well, and we express our sincere sympathies to those for whom that is not the case. Here in Cambodia the transmission rate has remained remarkably low and we are extremely thankful for that. However, as we mentioned in our last report, the effects of the virus on the global situation has still had a significant negative impact on Cambodia. The tourism and garment production industries are two major industries here in Cambodia and both have been dramatically impaired by the current situation. Many families have lost their sources of income and face significant need. Increased family vulnerability means increased vulnerability of children. Children In Families continues to be committed to strengthening families to care for children in the midst of this crucial time.

The Covid-19 situation reminds us that there are so many things that we take for granted…like being able to access vital medication for a child with cystic fibrosis. There is only one pharmacy in Phnom Penh which has carried this medication and when we went to purchase more we were told that they did not have it and did not know when they would be able to get it in again. The reason – Covid-19. We have been able to source this medication through a couple of other avenues in the past, but none of those avenues were available to us within the timeframe in which we needed the medication. Fortunately, a doctor we knew was returning to Cambodia from the U.S. We were able to have her bring enough to supply this child’s needs until we are able to secure another source. Getting the medicine from the U.S. was much more expensive than getting it here. This medicine is vital to this child’s well-being, however, so we were grateful that, because of generous donors through GlobalGiving we were able to meet this unexpected expense.

Other Challenges

In addition to the challenges of dealing with Covid-19, it is currently rainy season in Cambodia, and a very rainy one at that! Our dedicated staff continue to make visits whenever possible. Accessibility is always an issue for people with disabilities in Cambodia, but even more so when the only way in or out of their home is a narrow flooded path. Because the ABLE Project staff provide in-home therapy, children receive the services they need without having to travel. In many parts of Cambodia this type of service is not available and families have to travel long distances to city-based centers if they need therapy. The end result is that many do not receive the care that they need. And, for those children who do need to travel, such as our children who have HIV and need to visit the health centers to receive checkups and medication, the ABLE Project assists families with travel costs and, when necessary, medical accompaniment.

With support from ABLE staff a child who is deaf has been receiving training in sign language online through Zoom. Your support for the ABLE Project ensures that children have access to services which help them to remain healthy and to develop to achieve their full potential.

So, thank you again for your support of the work of the ABLE Project. Your giving allows essential services to continue for these vulnerable children and their families.

It is June, which means it’s time for another quarterly report from the “Therapy Services for 40 Cambodian Families” project.

A Different World

As you are well aware, the whole world is in a much different situation than we were in when we last reported a few months ago. I’m sure many of you have had to make quite few changes in the way you do things every day. It is the same for us. We have had to balance the risk of virus transmission with the potential impact of putting therapy services on hold for the vulnerable children with whom we work. So, while we are encouraging social distancing and recommending that staff work from home when possible, we have not gone into shutdown mode or complete isolation like many have had to do. We have reduced our visits and are checking in with families remotely by phone in cases where that can be done effectively. However, quite a few of our clients have continued to receive in-person visits, albeit with strict hygiene procedures and use of protective barriers. As this global pandemic continues to stretch on, we do not believe it would be in the best of interests of the children and families with whom we work to have all therapy services halted. Yet we will continue to be extremely vigilant to practice in a way that we hope will ensure their safety and the safety of our staff.

The Bigger Picture

Though, thankfully, the Covid-19 virus has, to date, not taken a hold in Cambodia the way it has in many places, the economic effects of efforts to prevent the spread, along with the local impact from the global economic decline, are tremendous. Many people have lost their livelihoods. We recognize this is true in many places, but here it means a very real risk of starvation for families who live day to day on what they earn, with no margin and no “safety net.” In addition to continuing services and our regular financial stipends to families, Children In Families is providing additional emergency financial support as well as supplying them with hand sanitiser, soap, and face-masks. Your continued support of this project helps enable us to provide for these critical needs.

Promoting Inclusion For All Children

There are currently 69 children included in the ABLE Project. We are being stretched in our capacity, because what we offer in making family based alternative care inclusive of children with disabilities is so rare. Covid-19 is causing a lot of activities to halt, but referrals of children and families to Children In Families and the ABLE Project are not slowing down. When you support this project you are not just enabling children to receive therapy services, you are helping to make it possible for them to enjoy their right to a family.

So, thank you again for your support of the work of the ABLE Project. Your giving allows essential services to continue for these vulnerable children and their families.

Links:

• Srey Ny and Lisa share about ABLE in the age of Covid-19