PROVIDING PHYSIOTHERAPY AT THE LOCAL BUDDHIST PAGODA; A CASE STUDY OF AN INNOVATIVE AND INCLUSIVE PRACTICE IN NORTHERN CAMBODIA

S. Meak¹, R. Crockett¹, K. Clark¹

¹Safe Haven, Physiotherapy, Siem Reap, Cambodia

Background: It’s estimated that Cambodia has one of the highest rates of disability in the world (1). The country’s rural nature complicates access to school and rehabilitation services, isolating children with disabilities (CWD) and their families. Cambodian CWD are less likely than their peers without disabilities to attend school for any duration, more likely to be out of school, less likely to complete primary school (2). Ninety-five percent of Cambodians are Buddhist and believe in Karma; many believe people with disabilities have done a bad thing in a previous life and deserve their disability, further compounding the social isolation (3). Safe Haven, a small NGO based in Siem Reap, Cambodia, provides field-based intervention for CWD. On average, 2-4 staff from Safe Haven, traveling by tuk-tuk or motorbike to remote areas of Siem Reap Province, were spending an 8-hour work day providing services to 2-4 CWD in their homes. In 2021, child find efforts in Siem Reap Province by the Ministry of Social Affairs, Veterans & Youth Rehabilitation increased referrals to Safe Haven by 100%.

Purpose: This case study describes an innovative, inclusive and low cost way to increase physiotherapy services for socially and physically isolated CWD and their families in rural northern Cambodia, by hosting a mobile clinic at the local village Buddhist pagoda.

Methods: Mobile pagoda clinics were planned in 4 Siem Reap Province Districts that had the greatest number of Safe Haven clients. The Village Commune Chief in each village gave permission to hold a clinic at their local pagoda. Safe Haven physiotherapy staff were responsible for bringing supplies and equipment such as corner seats, wheelchair repair tools, positioning wedges, standing frames in case families could not bring their own or their adaptive equipment required adjustments. Once at the pagoda, stations were set up on the ground with grass mats and/or tents. Each family and their CWD remained in the same station while Safe Haven staff rotated every 30 minutes.

Results: Beginning May 2022, 12 mobile pagoda clinics were completed in 4 Siem Reap Province Districts; Sotnikom (1), Angkor Chum (5), Chikreang (5), Puok (1). A total of 73 clients were seen, averaging 6.1 clients per clinic. Safe Haven staff traveled together in a special vehicle an average of 59 km and 1.25 hours to reach the mobile pagoda clinics. Physiotherapy visits consisted of home program follow-up, gait, mobility, range of motion and equipment checks. Safe Haven nursing, social work and intervention staff also provided services.

Conclusions: In 5 months at mobile pagoda clinics, Safe Haven physiotherapy staff treated twice as many CWD than they normally treated in five months of individual home visits. Parents had an opportunity for group socialization and support. CWD were not treated in their most natural environment including assessing adaptive equipment use.

Implications: In rural, low-resource communities, utilizing the local Buddhist pagoda or other community center as a mobile clinic site is an efficient, effective and environmentally friendly way to increase physiotherapy services to CWD, in addition creating a shared social experience among families present.

Keywords:
pediatric physiotherapy
disability & rehabilitation
community based rehabilitation

Topics:
Disability & rehabilitation
Paediatrics
Community based rehabilitation

Did this work require ethics approval? No

Reason: Ethics approval was not required because this abstract describes a new practice development for Cambodian field-based rehabilitation service provision, which was entirely new and innovative for the culture and context. The project was born out of a need to change the practice paradigm due to a doubling in number of referrals without the ability to increase staff numbers. Regardless, the organization Executive Director, representing the Board of Directors and the Country Director, representing staff have written a letter of support, declaring adherence to the highest level of ethical values by staff in all areas of practice.