Feature Article
MOBILITY MENTORING IN UNDER-RESOURCED COMMUNITIES
Well-designed, properly fitted wheelchairs enhance mobility and open opportunities for education, work, and social interaction for those who require such support, which is why Amira Tawashy's work mentoring rehabilitation workers in under-resourced places like Southeast Asia, Eastern Africa, and Ukraine is so important.
Amira is a Dalhousie graduate who teaches in the Dalhousie Occupational Therapy program. She also works as an international consultant to the World Health Organization and is an outspoken member of the International Society of Wheelchair Professionals and the Halifax-based Wheelchair Research Team. Amira recently returned from Dnipro, Ukraine, and found a few moments to share some insights from her recent experiences.
Most Inspirational Moments
The most inspirational and rewarding experiences from my trips are always the people. Ukraine is no different. The health care workers work tirelessly and are eager to learn. As a woman, I was especially inspired by the young women working in the hospitals due to their generosity, spirit, and compassion.
Biggest Challenges
Of course, the ongoing war in Ukraine is the single biggest hurdle at the moment. Intense hostilities have triggered mass displacement and a humanitarian crisis. Significant threats to personal safety continue to occur daily throughout the country. For example, during a single 24-hour period in Dnipro, there would likely be 14 -16 air raid alarms (loud sirens that echo throughout the city), encouraging inhabitants to take shelter due to air activity in the region. Though most establishments now have generators, Russia often targets power stations that impede cities' ability to provide hot water, heat, and light. And, as it is well published in the news, missiles regularly hit civilian homes and hospitals: I saw an apartment block in Dnipro that had been decimated by a missile attack, killing more than 50 innocent people. Last week, more than 20 deaths occurred in Odessa due to explosions at a hospital, killing both civilians and first responders. As an outsider working in the southeast region of Ukraine, I found it took some time to become used to the ongoing noise of the sirens, the loud explosions, and the feeling of perpetual danger.
Work efforts are also hampered by ongoing challenges with broken supply chains and restricted mobility, both due to the ongoing war. The air space above Ukraine is closed for commercial airlines, so all travel and most imports/exports are via road. From the city of Dnipro (my duty station), the closest airport is in Chisinau, Moldova—an 11.5-hour car journey away. From there, the trip back to Halifax typically occurs via Warsaw and Toronto, taking a total travel time of about three days.
Most Important Policy/Practice to Implement
It is hard to pick just one! With that being said, I think ensuring that all wheelchair users have the opportunity to be as independent as possible with their mobility would be my primary goal. This means a few things:
1)Wheelchair users should be afforded an appropriate device that enables independent mobility. Many wheelchairs donated to under-resourced settings are heavy and have rear wheels set very far back on the chair, making independent propulsion almost impossible.
2)Wheelchair users must also receive the appropriate skills training to use their wheelchairs. This means being taught how to propel efficiently over rough terrain and navigate environmental obstacles.
My current role in Ukraine with the World Health Organization is collaborating with the Ukrainian Ministry of Health to rapidly scale up rehabilitation strengthening, particularly regarding wheelchair provision. As such, I am providing quality assurance to ongoing wheelchair procurement projects and facilitating practical training with current healthcare practitioners to improve wheelchair provision efforts throughout the country. This is of particular importance now, as wheelchairs are an essential device for the management of health conditions common in wartime, such as spinal cord injuries, brain injuries, complex limb trauma, and amputations.
Dal School of OT Influence
Understanding and appreciating the role of occupational therapy within the broader healthcare system has certainly facilitated my international work. When I started my MSc studies at Dalhousie, I barely knew what OT was, let alone how it fit in with the broader context of community health. With respect to my current work, thousands of Ukrainians have sustained injuries which require rehabilitation. Being able to describe the impact which the initial injury and subsequent long-term health conditions, disability, and ongoing rehabilitation will have on the individual's ability to engage in their occupations throughout their lifespan is a unique skill of an occupational therapist.
I also became very interested in wheelchair provision during my SOT Dal student learning and started to look for ongoing opportunities in this area. I started focusing on wheelchair provision in my first role with Nova Scotia Health. I continue to pursue education opportunities to further my knowledge and experience in this field of practice. Though many facets of trauma-related health care can be addressed in occupational therapy (e.g. hand and burn therapy, cognitive assessment and rehabilitation, and mental health care, to name a few), my contribution to the WHO efforts in Ukraine has been in wheelchair provision education.
Advice for Graduating OT Students
Be patient and grab every opportunity you can.