Work......

Top picture is the Cheshire Home where 19 chronic severely disabled peple live, many of them abandoned by their families.
Below is the Caricom Secretariat. Guyana sees itself as a Caribbean country and their linkages with the Caribbean are strong. I am trying to get info from the Health Secretariat but so far have drawn a blank.

I have hesitated to talk about work because at the beginning it always needs time to get settled and there is a tendency to be overcritical. However although I am finding the logostics difficult without the proper equipment I am getting excited about the project. It is so different for me because this time around it is not a clinical experience although I am making sure that I go to see as many centres as possible to get a true understanding of Guyanese culture regarding the delivery of Rehabilitation Services.

Firstly most people here do not understand Rehabilitation as it relates to treatment. The word is used as in Rehabilitation of the roadways, buildings and industries etc. So there is a real need for an awareness campaign - not in my project description however!

Secondly my visits to clinics and rehab depts have been both interesting and difficult.
The quality of care is so very different from even the poorest departments in Canada. Clients (patients) are still shackled to their beds if the nurses do not want them to get up while they (the nurses) watch TV and it is hard to observe without commenting. Many of the patients lie for hours in their own excrement and urine.
However it is good for me to see as it will help with curriculum development which will include Human Rights Awareness and I have hundreds of notes which I must try to include forcefully in the report without being too judgemental. I just have to think back to the situation in UK when I trained 40 years ago which was only a few steps up from this - especially in the mental hospitals.

Thirdly some of the Rehab Assistants have lost motivation and energy to continue their work under such difficult conditions while many of them have learned well and are providing excellent care with little or no supervision.

I have met with the Minister of Health, Dr. Ramsammy, and he is very supportive of the Rehab Degree programme, gave me free access to him and indicated that he is waiting to retire but needs my report before he does so as he wants to see the Degree programme as a reality before he moves on to other things. He also indicated that as soon as I was ready and he had approved it he would announce it and then' they'll just have to get on with it!'

I also met with the Permanent Secretary who said that he would allocate the necessary funds and was most encouraging about it especially if I took account of getting improved services to the Regions i.e the country areas outside Georgetown.

I have met with the Dean of the Faculty of Health Sciences who wants to see the Degree programme at the University of Guyana by the time he leaves his position next year! I see him again tomorrow to broach some of my ideas to him and seek his advice about how best to get accreditation by the University and to get the Rehab School established as an affiliate of UG etc.
He too has been generous with his time.

I have got feedback from many of the 48 Rehabilitation Assistants in the country and from the 3 physiotherapists as well as the VSO therapists working here. It is amazing how thirsty for education these young women are. I went to the National Library yesterday and saw a couple of them doing their continuing education projects there. They 'work' all day and then study at night and at the weekends, even the married ones. They are desperate to get on and to move along a career path to professionalism. I feel a great responsibilty to try and develop a model that will work for them and yet at the same time encourage them to remain in Guyana.

I am now researching the possibility of setting up a short term project that will encourage the Guyanese Diaspora to return to do much of the final clinical teaching rather than ex pats and VSO volunteers. The situation is not so bad for physios as there are about 6 or 7 practising in the country some in private practice, and we are expecting 7 newly qualified ones to return next year from their training in Cuba where they have gone on scholarships. The situation for Occupational therapists and Speech pathologists is dire though as the only ones in the country are 1 OT and 1 Speech both VSOs in the Ministry of Health under the Rehabilitation Services Directorate!!! ... and this for a population of ~750,000. Still I should be happy as we had 11 physios, 1 Speech and 2 OTs (including me) for 11 million in Malawi. I hear that Malawi is progressing slowly towards its own PT school and I hope to use some of their curriculum here!.

Given all the above and all the help I have had from colleagues in Canada I am hopeful that I will be able to get it all finished and a report written by April of next year. At present I think that my line manager does not understand what is involved and she is still expecting something by January 2007. I don't think I can do it.