Life without the NHS: working as a therapist in St Lucia

hannamcfaddenHanna McFadden, Children’s Physiotherapist, works for Honeylands, a Specialist Children’s Centre based in Devon. She has also been working with us at Designability to help develop Dynamic Seating for young children with dystonic cerebral palsy.

Hanna is currently on sabbatical over in St Lucia and has just shared her first account of how different medical treatment is there, along with some of the stories of the fascinating people she has met.

child-development-and-guidance-centreI’m currently working at the Child Developmental and Guidance Centre in Castries, the capital of St Lucia. Up until last year they were in a wooden hut further up in the city, but they received a number of grants which enabled them to move to a fantastic new building. The core team here consists of Kim, a paediatrician; Arethra, a psychologist and Elaine, a physiotherapist (the only paediatric physiotherapist on the island!) Other than that, they rely on charities and volunteers to come and support the work that is needed here. We currently have Gina, a speech and language therapist from the UK, who a charity have paid for; Caitlyn, an occupational therapist from the USA who is from the Peace Corps charity and little old me!

Life without the NHS

I have been working Monday to Friday from 7:45am – 4:00pm and my role is similar to my role at Honeylands. There is obviously no NHS here and people have to pay for their appointments, which I have found very difficult to enforce. Coming from a very different system, I feel uncomfortable asking for money at the end of the sessions and I am a bit of a wimp when it comes to it! Thankfully the receptionist takes care of that for me.

I am pleased to say that we are able to ‘bend the rules’ at times – if a family really can’t pay and their child still needs treatment, we make sure they are still seen somehow, or only ask for a contribution. This feels great for me, but puts pressure on the service. It’s a really tough one to get my head around. People here are generally honest and pay what they can, but the reality is that many of them live on very little money. Most of the parents of children I treat don’t drive, and there are no timetabled buses in St Lucia. Some parents struggle to pay the bus fare (approx. 25 – 75p), let alone the treatment fee.

Three buses and three hours to get to an appointment

I’d like to tell you about a little girl who came to see me a couple weeks ago. She has dystonic cerebral palsy. Her mum has a learning difficulty. They had to get on three buses to get here and it took her nearly three hours. She arrived four hours early for her appointment because mum wasn’t confident in telling the time, doesn’t have a phone and didn’t want to risk missing it. Despite her learning difficulty, she listened to every single word I was saying and wanted to practice the activities to make sure she was doing them correctly.

The mum’s shoe broke at the end of the session. It was her only pair and she was only upset because she had to carry her daughter (who is 6 and quite heavy) all the way back, on and off three buses. I managed to fix her shoe, for which I got a big hug and a kiss on the cheek. I was completely humbled by this mum who was an amazing human being.

making-a-wegde-to-give-anterior-pelvis-tilt-out-of-an-old-seat-base-and-piece-of-woodGetting creative with limited resources

In my spare time I have been making wedges out of old seat parts, bits of wood and brackets and fixing up standing frames that would have been thrown away in the 1990s in the UK. I have also been experimenting with pool noodles to see how I can fit them into chairs to make postural support. Things are very different here and it’s not always ideal for the children, but I must admit I have loved being creative and making use of these old bits of equipment!

In terms of the types of children I see, there seem to be more dystonic children here and I believe this is due to more children being born at term in remote areas suffering perinatal asphyxia. There are fewer extremely premature children (

We have Zika virus here and there are babies being born with microcephaly. I have treated two so far. I’ve been told that Zika is on the decline here, but there are parts of the island that are difficult for us to get to, so it is thought that there are more babies in these remote areas being born without any support.

Work aside, I can’t quite get used to the beauty of the island. Every day something amazes me. Things are so colourful here and just so beautiful. I’m not convinced the pictures do it justice.

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