The air is cool, much cooler than expected in July. We are on a tuktuk, heading out to the Cambodian school of Prosthetics and Orthotics. We have a follow up appointment for one of our foster care children, Leak (pronounced Lay-ak).
Like many of our foster care and kinship care cases, Leak has special needs, and is part of our ABLE program. ABLE (Accepted, Belonging Loved Empowered) is a broad-range, overarching program to assist children with special needs or chronic health issues. If a child is referred to CIF who may need assistance, our ABLE team follow up.. The team is led by our Khmer Physiotherapist Sreyny. Sreyny supervises two additional Khmer staff members and is assisted in her role by 2 technical advisors – Lisa, a pediatric physiotherapist, and Courtney, a mental health occupational therapist, both from the USA.
Bridging the gap
Once they receive a referral, Sreyny conducts a development assessment to see if the child meets the criteria for the program. A family and routines based interview follows. This helps Sreyny understand the needs of the child and the family’s capacity to support the child. The team then develop a care plan for the child and family. This could include direct therapy, nutritional or medical support, or other things. Today, it means providing transport to the family, and assistance at a medical appointment.
Often our staff are a bridge between medical professionals and the family. They are able to explain medical concepts and interventions in ways that families can understand. This family-empowerment is one of the ABLE team’s most important roles. They help families to not only understand the diagnosis of their child, but also provides hope that things can be done to improve their child’s quality of life. The ABLE program also pays for medical treatment and specialist equipment when necessary. When they have trouble sourcing specialist equipment – a common problem in Cambodia – they make their own.
Taking new steps
Today’s appointment is to look at Leak’s leg braces. Leak has neurological damage due to an infection he suffered early in life, and he did not receive much medical care prior to entering CIF care. His foster mother, Kimna, tells me that when he first arrived at her house, her neighbours gossiped about how thin his legs were. “They were mostly skin and bone,” she says. “But look, now you can see the muscle developing and he is learning to stand.” The excitement is clear on her face. She can see how the exercises and interventions she has been doing are making a difference.
We arrive at the clinic and are ushered through to the appointment space. Leak crawls around as we wait. He looks at himself in the mirror and plays with the building blocks with Sreyny and Kimna. They discuss his treatment and how he is finding his braces. A few months ago, Leak received leg braces. Worn twice a day, they hold his legs firm and prevent him from rolling his feet. For the first time in his life, at age 4, Leak can pull himself up and stand.
The ABLE team is thrilled by his progress. They think he can learn to take the next step. Here in Phnom Penh, it’s impossible to find a walker suitable for a little boy in a rural village. Imported walkers are expensive, and unlikely to be robust enough for a village that is the humid and dusty some months, and flooded in others. So the ABLE team have designed their own. Made from supplies easily accessible in the village, it can be fixed if it breaks, and grow as he Leak does. Now that he can stand, our ABLE Staff want his braces changed to allow him to keep his feet flat, and to bend his knees in preparation for walking. And that’s why we are visiting the clinic today.
Slow but steady
Sreyny and Kimna still have time before the Orthotist arrives. They manage to convince Leak to sit still and do some muscle exercises. Kimna shows Sreyny how they do the exercises at home. Leak participates willingly for a few minutes, but he is four, and soon wants to play with the next toy he has seen. He doesn’t know it, but that toy he wants to climb on is a tool to help him learn better balance. Kimna and Sreyny let him win that argument.
The Orthodist comes over and hears what Sreyny would like to do. “I need to check with my superior,” he says disappearing. He comes back a little while later. “I’m sorry, we think he needs to be in these braces until September. We will change them then.” Sreyny and Kimna share disappointed glances but nod and we leave. Medical treatment is slow the world over, and sometimes it’s even slower, here. We leave without the change we came for, but not before Leak gives a beaming smile to all the other patients and staff.
A child’s progress is often difficult. Navigating complex medical care in Cambodia is challenging. But our ABLE staff are there every step of the way, helping families get the help they need, to care for their child the in best way possible. Sreyny and the team will continue to journey with little Leak and his foster mum, Kimna, until he can stand on his own two feet and beyond. And when he can do that, they’ll help with the next step in the journey too.