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Making a difference in South Africa

Malamulele Onward NPC is a non-profit organisation is dedicated to improving the lives of children with CP in South Africa; achieving this by training therapists in effective therapy and support practices. For their work improving the quality of Medical-Therapeutic care for children with CP, the organization has been awarded a World Cerebral Palsy Day 2018 Merit Award.

In the last five years, Malamulele Onward NPC has trained 453 health professionals, allowing them to have an impact on the services delivered to children with CP, and their caregivers in over 151 different hospitals, clinics and schools.

The project

Malamulele Onward NPC (MO) was established in 2006 with the mission to address the unmet rehabilitation needs of children with CP in rural areas of South Africa.

The team initially focused on providing therapy and educating caregivers, however they soon realised to make a long-term impact on the lives of children with CP, support services as a whole needed to be strengthened.

“For the long-term sustainability of the change to be brought about in the lives of the children and their caregivers, we recognised that we needed to create a supportive environment for them, which included the local rehabilitation services at hospitals and primary health care centres.” – Dr Gillian Saloojee, Founder and Executive Director

In order to do this, MO has developed a number of Health Professionals Council of South Africa (HPCSA) accredited training courses for therapists working with children with CP.

The courses aim to address the main barriers preventing South African children with CP and their families from receiving effective therapy and support.

Such barriers include:

  • conventional therapy courses that only give graduates very limited skills for treating children with CP
  • high demand and low resources which mean that children with CP are not receiving sufficient therapy
  • therapy that is child-focused and neglectful of caregiver training.

MO estimate that on average children with CP in South Africa only receive 35-40 hours of therapy during their lifetime.

MO’s courses are designed to help build confidence and capacity in the therapists via three key concepts promoted throughout their courses:

  • A primary focus on the caregiver as a vehicle for therapy
  • CP as is a way of life – these children live with it 24/7 and therefore programs should be based on that. For long term impact, therapy must include equipping the caregiver with knowledge and skills in relation to handling, positioning and postural management. This is shifting therapists’ approach from a medical model to a social model.
  • The benefit of group therapy sessions to increase therapy time for children and to create an environment to teach caregivers the necessary skills.

Since the first offering in 2013, the course structure has evolved to meet demand. Now, as well as a six-day introductory course, there are intermediate courses and one-day workshops available. All courses are aimed at occupational therapists, physiotherapists and speech therapists, as well as therapy assistants and technicians in these areas. Other disciplines are now beginning to also see the value in the content.

“We do not turn anyone away from our training courses and this has resulted in dietitians, teachers, psychologists and orthotists attending the training,” explains Misty Weyer, Training Coordinator.

Understanding the challenges

Designing and delivering the training has not been without significant challenges. For one thing, ensuring training is accessible across rural areas presents logistical and financial hurdles. Fortunately, MO are still able to keep participant course fees affordable thanks to the support they receive from donors and partnership arrangements. The vehicle support they receive from Europcar is one such example of the donor and partnership arrangements in place.

Ensuring content is relevant to the participant’s contexts is also an ongoing challenge for the team, as many therapists work in poorly resourced areas. The team spend time regularly working on site with therapists – to get an understanding of their challenges – so that they are continually developing effective solutions.

“These challenges do not remain static. They change, and as they change, the content of our courses must change. Thus, we revise and edit our content before every single course we run – we do not run a generic course that remains the same as time goes on.” –  Misty Weyer, Training Coordinator, MO

The MO team also understand how hard it can be to take new skills and ideas back to an established team.

Either the team rejects these skills due to a lack of understanding CP, or a child is not seen by the same therapist each time, and thus different approaches confuse the child and caregiver.

“On the last day of our course, we prepare therapists for this experience and encourage them to plan their approach for returning to their hospital,” explains Misty.

The team also provide remote support and ongoing mentoring to ensure a successful learning experience for all participants.

Making a difference

In addition to the hard and fast statistics quoted at the top of this story, the MO team have received positive feedback from many of their participants regarding an increase in confidence and competence when treating children with CP.

One participant has been quoted as saying:

“I have a new understanding of CP with regards to its impact on the child’s and their mother’s everyday life. My focus has been completely shifted from physical impairment focus to understanding the importance of participation and function…My confidence has improved dramatically. In fact the course has surpassed my expectations by removing my fear/anxiety and replacing it with a love for CP.”

Seeing the benefits first hand, eight hospitals now routinely send their new community service therapists for training with MO.

The Department of Health is also funding training and requesting specific courses be delivered in areas of need.

The MO team have also developed a Carer 2 Carer Training Program, which trains caregivers to facilitate workshops for their peers, assist with running therapeutic groups at local CP clinics, lead support groups, and in some cases, conduct home visits to children with CP living in their local area.

The MO team – along with the health professionals they train – are certainly doing remarkable things to make a difference in the lives of children with CP and their caregivers.