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Fiji is not a place that accepts physical disabilities as a society. Nothing is ADA-accessible to even a mild degree, which makes my daily commute a constant adventure. I knew I was entering this country with added challenge if I was going to require a wheelchair for walking tasks. Once that notion became a lived experience, the anticipated challenge was so much harder than I could have imagined. One of the most shocking experiences I endure multiple times during my work commute is random people walking up to me, blocking the path, and asking why I am outside in a wheelchair. Comments such as “you cannot be out here as a woman like that!” or statements that prod at my personal information like “What happened to you? What did your doctor say?” happen nearly every day. Sometimes it’s humorous, other times it’s bizarre, and most of the time I am just overwhelmed as to why a complete stranger is touching me or demanding answers to questions about my health. Frequently, they will not even speak to me, they question Justin directly as if I am invisible. I had many concerns about how my patients would view me, but this has ended up being easier than I anticipated. My yoga programs I wrote before coming to Fiji had to be changed to a sitting position on the floor or in a chair. I had fears of my patients disliking my classes because they would be taught in this manner, but people are surprisingly adaptable. What I have also found, is that my classes have required adaptations regardless of my own injury because my patients ALSO need adaptations. Thus, the nature of the class needs no explanation. Most of my patients have never done yoga either, giving me a blank slate to work with and formulate my classes however I want. I gained trust from the kids at the special needs school quickly, because I was relatable as a person navigating my environment with a disability. At the hospital, I generally assist with upper extremity patients, so I get to sit during patient treatment. But most days I am asked by other patients if I am in the physio department for treatment, and I catch them by surprise when I say, no, I'm here to give you treatment. I’m trying to see things in a light that offer growth and flexibility. But there are days where I feel knocked down, because it’s all just too much. Last week I was exhausted, sick of being in a wheelchair, sick of the stigmas, tired of being constantly stared at, and overwhelmed by the cultural differences. The chronic pain I push through each day breaks my focus at times and I yearn for normalcy. I had to stop and reset. This type of environmental setting is not new to me, but the wheelchair makes me feel like an alien in my own body. Self-care has been pushed to the side for many weeks so I can focus on the care of my patients. But we all know that if we don’t take care of ourselves, we can’t take care of others. I was not practicing what I was preaching. Justin and I were long overdue for a weekend vacation. I have been logging many overtime hours on Saturdays working on my projects so they are ready for the following week. But not last weekend. Justin and I found an affordable resort to the west of Labasa and made a last minute booking. I eagerly counted down the minutes to sleeping on an actual mattress and having a hot shower. The true luxuries in life are the little things we take for granted. The weekend was a dream. We slept in and ate fresh fruit and vegetables from the organic farm on the premises. We kayaked to a secluded beach and swam in the private pool under the palms. We spent our afternoons reading on the porch and staring at the big blue ocean. I tried to let go of any school tasks on my mind (emphasis on tried) and treated the weekend like time off. The life changing magic of self-care should never be underestimated. I was torturing myself for a while by continuing to hide my physical limitation I am currently living with. I posted one photo on Facebook exposing my reality, and thereafter continued to portray myself on social media in a wheelchair-free manner. I am slowly accepting my reality. I mean, do I have any other choice? I still shudder when I see my reflection in a wheelchair. Self-love is complicated. The cultural stigmas in Fiji amplify my desire to hide this part of me. Fiji’s culture wreaks havoc on my ego, but at the same time it brings me peace. I don’t know anyone here, and the people I am meeting don’t know my past. I have nothing to live up to or explain of my changed life. I don’t always have the gumption to stand up for myself, but when I do, I hope I can use the abrupt confrontations from strangers in the street as an opportunity to educate people about disabilities. Fiji is not progressive in this manner and badly needs reform. Simply being out in the community, no matter how horrified passersby are by the sight of a woman in a wheelchair, is a means to show the community that everyone is capable of participating in daily life. And now, some snaps from the weekend.  An activity that doesn't require my leg, yay!  Our private beach we found while kayaking.  Floating through the afternoon  My favorite snack  The premises from above. Jungle paradise!
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 A shot from Justin's drone. This is our backyard. Things are finally in a routine here in Fiji and I feel like I’ve hit my stride. Last week I started consistently working at the hospital, and my yoga programs at the school are running on a regular schedule. Quite the change from my last post! There’s no debating the challenge of my first two weeks in Fiji, but with much persistence, things are happening. A big change that happened for Justin and I is we moved into a home with a family of 6. Our former living arrangements fell through, which was added stress to the former chaos. Justin and I were at a loss of what to do initially given we didn’t know anyone in our small, rural town. We went around the neighborhood asking around about room rentals, and to our surprise, multiple families eagerly offered us a place to stay. Can you imagine such a thing in the United States – two foreigners scoping the neighborhood, knocking on doors, asking around for an extra sleeping space? Small community support is strong here in Fiji. We are in tight living quarters for the next few months, all 8 of us sharing one bathroom with paper-thin walls, but it’s amazing how comfort can be found simply by the fact that we are around loving and hospitable people. The kids are nonstop energy (age 2, 6, 6, and 12) and the mom is a total rockstar. She insists on doing all our laundry (by hand) and cooks all the meals over kerosene and open fire. We feel lucky and well cared for in our new living space. I am very much an introvert in how I recharge, so I have to find quiet spaces to myself during the workday, which is impossible most of the time. I am in my second week of my pediatric yoga program, focusing on executive function skills development for one of the middle school classrooms with moderate learning disabilities. My data set is small thus far, but it has been fun to see how the kids change their focus and divert their energy over the course of each session. I have also had lots of positive feedback from the teachers from my chair-yoga class for stress-management. Yoga is my primary avenue for delivering services, but all of my interventions still remain in the realm of occupational therapy. The hospital has been an eye-opening experience. I have been given high respect and responsibility since my first day, which I wasn’t expecting given I am an outsider with a physical disability. I feel very trusted, which is empowering, but also stressful at times given we see a wide range of diagnoses in the hospital. The physio staff has been a delight to work with. There are four physiotherapists and one student, all rotating through the inpatient ward, outpatient unit, and home visits. Every Friday there is a Diabetic clinic that I got to be a part of last week, which involves an influx of patients from all over the island. We provide education regarding foot care, exercise, and other relevant topics to their diagnosis. Wednesdays are my favorite day since there is a hand surgeon on staff and I get to see all his post-surgical patients. My first Fieldwork rotation in Arizona was in hand therapy and happens to be my preferred work setting, so I was over the moon to learn I would be working with this population in Fiji. When a patient with a hand injury walks in our door, the staff looks to me to take charge. I’ve had to act fast and be creative with very few resources. All my free time outside of work is spent reviewing my school notes, calling mentors to problem-solve, and digging through the literature. The surgeon on staff does not have a traditional MD. I learned from a staff member that medical doctors in Fiji usually obtain a Masters in Allied Health. I was slightly horrified upon learning this, but this is how things work logistically in developing countries like Fiji. Sanitation measures in surgery are nil compared the U.S., leaving the risk for infection unnervingly high. Amputation is common, especially given the rate of Diabetes in Fiji. Rehabilitation protocols are not always effective or evidence-based, even when written by the surgeon. Standard patient evaluations are not done with patients on their first visit, which has forced me to be creative and quick with my assessments. When time is available and there is no line for therapy, I spend much longer with patients, asking evaluation-based questions and developing therapeutic exercises and routines they can use as a home program. My impression why evaluations are not completed is that many patients travel from far away and do not always return for a follow-up to the hospital, so formal evaluations are thought to be excessive. I think you get the picture by now that things are different here! And I expected them to be, which has been invaluable to my learning regarding global health. Fiji won’t be the end of my international endeavors, and it is important to me and my own learning to see through the lens of other cultures in how healthcare is delivered. When a protocol is not evidence-based, it does not necessarily mean it is wrong. Most developing countries don’t have the resources to conduct research in the first place, and when basic resources aren’t available, treatment unfolds in a way that is distinct from the process in another country. It’s easy to be on the outside and say ‘that’s the wrong way to do it’ but keeping in mind the environmental, financial, and remote factors influencing the system, I can understand that protocols taking place are the next best option. I am slowly learning the complexities and hardships of healthcare in Fiji. As a way to share ideas and openly discuss the layers of health services, I am writing an education series for the staff that involves weekly presentations of evidence-based practice. To lay down the foundation, I started with a lecture on the basic practice of OT, our role in rehabilitation, our value to global health, and why OT is of benefit to Fiji. At the end of the presentation I left time for discussion to share ideas and problem-solve ways we can merge our backgrounds in therapeutic intervention. It was fascinating hearing the staff bounce ideas on how to simulate therapy tools and interventions used in the U.S. They are the real experts here since this is their home turf. Another really fun thing I get to be a part of on Thursdays is a prenatal group session for first-time mothers. Attending mothers come from all over the island to learn about the basics of pregnancy, anatomical changes their body is going through, how to manage pain and discomfort (cue, yoga!), and the stages of labor. In the U.S. someone would generally just pick up a book and read about these things or ask their doctor at a routine visit, but this is Fiji. Many people don’t have access to books OR internet. If they are traveling from hours away on the opposite side of the island, it might be the only time they see their doctor. This class might be the only time they learn information about their pregnancy from a medical professional. Lots to juggle, and lots to keep me busy. I’m excited for what the next two months has to offer here in Fiji. Here are some snapshots of life the last two weeks.  Our new roommates!  Sheep grazing the roads by the sugarcane, down the way from our home.  Yoga with my middle school class. Teaching them breathing techniques :).  Chair-based yoga class with the teaching staff for stress-management.  First of my lecture series! What is OT - How it is used for rehabilitation - Why it is Important to Global Health - How can we Integrate it into Fiji Healthcare Services  Yoga Exercises for the Prenatal Group  Yoga Exercises for the Prenatal Group  The most important thing yoga teaches us is not the asana, or postures, that we hold for exercise. As I have described before, yoga is a study of self-healing and a way of life. Central to the practice, there is the notion that our external world is out of our locus of control, and it will never be in our control even if we perceive it to be at times. Yoga helps us to feel centered in the chaotic external world. Cue, total disorder in Fiji. That might sound kind of dramatic, but if you read my previous post and have been following some of my stories, you probably know what I’m talking about. It’s the peak of tropical storm season, and Cyclone Gita pummeled through southern Fiji earlier this week at a category 5. We were very lucky in our village not to be hit by the belly of the beast, but Tonga is in a state of emergency and practically under water from flooding. Additionally, our visa extension has still not been stamped and we are 3 days past our current visa. Our application materials are in, but the process leading up to this was not promising, with lots of mishaps and headaches. On the school-front, my residency has been crumbled and re-built a few times since my arrival. Culturally, things run at a different pace in Fiji, but I have also planned this trip for almost a year with my objectives in place with my prospective entities in Fiji so it has been confusing to me as to why prior agreements were nil when I arrived. Flexibility is an understatement. My specialization in adult treatment is not my leading focus as I had first planned, and has shifted to pediatrics, because that is what is currently available. It nearly compromised my capstone, and it took lots of unplanned hours and late nights re-writing session plans and data grids. Serious gratitude goes out to my OT mentors who have given many hours of their own time in aiding me through this process. Every time I get off the phone with my mentor in Phoenix I spend about five minutes thanking her, and it is worth every penny of our limited internet. So here I am! Hanging out in Fiji with a brand new residency. Thankfully it is still yoga-based, which was a requirement since my first month gaining my certification in India had to be tied to my residency per obligations of the national board. Most importantly, my new residency is of benefit to the community of Labasa, which is why I am here in the first place. If this project was not tied to school, I would be stress-free, and using my skills as needed anywhere and everywhere as the day presented itself, but that is obviously not reality. Damned be the real world.
Dare I present to you my current project? Please pause for a minute and find some wood to knock on for me.
I started a yoga-based stress-management class for the teaching staff that I am running weekly, using a perceived stress scale and mood scale to measure outcomes. On Monday I begin one of my primary residency objectives which is a yoga-based program for improved executive functioning, with a focus on increased sustained attention and mood control for school-aged kids. I am running this program 3x/week in a classroom with kids 11-18 years old, who have attention deficits and other executive functioning limitations. I am really excited about this program and hope there will be good outcomes with the assessments I am using. The teacher is a fantastic support and is on board with the program as well, which is truly the backbone to making this possible. I have approval to work at the hospital too, which is a sliver of hope to use my adult program I had already written out in length. Pending connection with the supervising liason, I will be able to get into the physio department to work with the amputee population. Lots of blessings come with change, yet some are under muddied water at first glance. In the midst of these changes, one of my mentors suggested adding a side objective of journaling about my use of the yogic Yamas and Niyamas to facilitate flexibility and resilience in a cross-cultural clinical experience. I have been digging deep into my yogic stores in this realm, so for those who aren’t familiar with those terms, let me describe their significance. Yamas and Niyamas refer to one’s personal moral guidelines, which we use every day in our interactions with those around us and our self. Yamas include components such as nonviolence, truthfulness, and non-greed, while Niyamas include contentment, self-study, and self-discipline, to name a few. Think about these components as such – if you were to attempt a project or a new job without first addressing that you are anxious, depressed, or violent, those traits will rear their head in future experiences. It is essential to have a strong foundation of moral precepts in order to contain your newfound energy, otherwise you may unintentionally disturb or harm another person’s autonomy. The Yamas and Niyamas can be interpreted very literally, such as not hurting another person under the precept of nonviolence, or it can mean refraining from gossip or complaining about others. Certainly something I am being tested in with the changes of my former agreements going nil, but it does nothing good for myself or society to spit fire at them. And so this is yoga, establishing safety and steadiness in a life of constant change, with many milestones left without conclusion. Nothing truly is in control, but our ethical compass can serve as a means to shape our reactions to disorderly experiences. It is our choice how we portray ourselves to the world, and inward to ourselves. I am embracing Fiji for what it is, and what is to come. All I can do is present myself as I am, with what I have to offer. |
I am an outdoor and travel junkie who is currently completing my doctorate in occupational therapy overseas in rural Fiji. On Sweet World Travels you will find stories of my life with my husband, the communities we serve, and the many adventures we take. Archives
April 2018
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