By Sophie McMahon.
Sophie McMahon is an Occupational Therapist (OT) currently completing an AVID assignment in The Dong Nai Province, Vietnam. Her role is to work as a therapy trainer, and develop an OT service within the local hospital. She is the second Australian OT to work with this health service, and also collaborates with an OT volunteer from JICA (Japanese International Cooperation Agency).
“I miss being able to control my emotions around my family – sometimes I can’t stop laughing and sometimes I can’t stop crying.” This man’s contribution is greeted with nods and an understanding chuckle around the circle.
It is mid June 2017, and I am sitting with a group of men and women who have recently had brain injuries and strokes, along with two local physiotherapists, who are facilitating our first ever group therapy session at the Dong Nai General Hospital. It’s not common to talk openly about sensitive topics like emotions in Vietnam culture, especially in a medical system where so much focus is placed on physical impairments. But with my counterpart Huong’s caring manner and gentle encouragement, the patients begin to open up about their lives. They are surprised to find that they are not alone in their struggles.
“Last week I smashed a bowl. Since my stroke, I am always dropping things and it really frustrates me,” confided one lady.
A man on the other side of the circle suddenly rose to his feet (with an apparent new found balance) and leaned across the table to shake her hand. He responded to the woman in Vietnamese, which I feel would roughly translate in Australian to “Mate! The same thing happens to me all the time!” Everybody laughed and I felt the room relax. Huong and I exchanged excited looks – we were seeing a side of these patients that we had never seen before!
I am an Occupational Therapist on assignment with the Australian Volunteers for International Development (AVID) program, an Australian Government initiative. Australia’s involvement with The Dong Nai General Hospital began in 1954, when the government provided financial and engineering assistance to enlarge the hospital. This year, my job has been to train staff in therapy techniques for patients with traumatic and acquired brain injuries. Traditionally, the Rehabilitation focus in Vietnam has been purely physical. Our goal this year has been to broaden our skills in the areas of cognitive, perceptual, speech, and emotional recovery. The staff have shown great interest and motivation to work in a more holistic framework, and continue to impress me with their creativity and compassion.
We decided to trial group therapy as a way to ensure that a number of clients could receive therapy even when there is limited time/staff. The goals of our group were to give patients a chance to:
- receive cognitive therapy (retraining for memory, attention, problem solving, and other executive brain functions);
- practice their speech and communication in a real life setting;
- incorporate upper limb therapy into functional activities;
- discuss adapting to their new life post injury with other patients who understand, in order to increase insight and emotional adjustment; and
- increase their confidence to participate in family and community activities overall.
The benefits of group therapy are well documented in the literature, but the challenge has been to find a balance between what we know works in Australia, and what can be applied in Vietnam. Imagine if it was as simple as applying every therapy technique we know to every person in the world with the exact same results! But, alas, we are a world full of unique individuals, and unfortunately no chance of ‘one size fits all’. Living with a Vietnamese family here has helped me to understand this on a deeper level. So while my job has been to bring the theory, the local staff and I work together to come up with creative ways in which we can apply this to our cultural setting. Although this can be challenging at times, we have shared many exciting ‘lightbulb’ moments together.
The biggest thing we have observed since running the groups is the patients’ lifted mood and motivation. As they continue to build their confidence in communication and functional cognitive skills, we are seeing a flow on effect with patients integrating back into community activities and family life. One participant reported that she looks forward to Thursdays, as it is the one day where she is able to focus on her strengths in an activity, rather than her impairments. Her family have noticed that she can’t stop smiling for the whole day at home after group therapy. She stated that she feels more confident in her abilities to tackle her everyday activities, having been given the chance to practice with other like-minded people. Long term, I hope to see these patients starting to speak out and advocate for themselves within their communities. When they are able to brainstorm together, we often see them coming up with solutions and ideas that we therapists never dreamed of! And this is the beauty of placing them at the centre of their own goal setting process.
I am so proud to have been a part of something in the early stages of recovery that empowers men and women to take charge of their own futures – “Nothing about us without us”.
Our Head of Department has expressed that he is committed to continuing this group therapy once my assignment has finished up. I think it is a fantastic achievement of our regional hospital to be at the forefront of holistic rehabilitation, and their commitment to disability inclusion under challenging circumstances is admirable. One staff member remarked recently that she had felt a big shift this year in the way staff think about and approach therapy. Although difficult to measure of course, I feel this is a great step forward for us.
Everything considered, I have to say that the best part of the groups is the laughs we have. Life is messy, and when we can open up about this, laugh at ourselves, and forgive ourselves, I think we can all achieve emotional recovery and peace. It is not uncommon for the group to finish up with tears of laughter from both patients and staff alike. Their smiling faces will be forever etched in my mind.