Charlotte's Moldova Q&A for RCOT

I had the awesome experience of being interviewed by the Royal College of Occupational Therapists (RCOT) about volunteering in Moldova. The full article can be read in the April 2024 OTnews.

Charlotte with the delegates.

Q: Can you tell us some more detail about your career in postural management? 

A: I have worked with children with complex needs since I was a teenager. What began as volunteering at a playscheme, led me into the career of occupational therapy - which I continue to love. When my nephew (who has multiple disabilities and medical needs) joined the family I started to really understand what life is like to love, and want the best for, someone with complex needs. 

Over the course of my career I have completed the Oxford Centre for Enablement “Posture Management for Adults and Children with Complex Disabilities four day course and the Active Design 24 hour postural management course. I realised my ambition of working at Chailey Heritage Clinical Services from 2012, where I was able to work holistically with children and young people with complex neurodisabilities. I then went into private practice, specialising in paediatrics.

Q: What led you to first identify the need for training therapists in Moldova - or were you invited to do that - and how did you go about developing your ideas and building a training programme? 

A: Working in independent practice, I saw a lot of privately purchased and now outgrown and unused equipment sitting in clients’ houses, gathering dust and getting in the way! Families were often asking me if I knew of any worthy causes to which they could donate it. Remembering the images and documentaries about the children living in very difficult conditions in Eastern European orphanages in the 90s, I contacted Martin at Child Aid to Eastern Europe, to see if he had any ideas about using the equipment. Several years later, Child Aid have sent out multiple shipments of equipment kindly donated by children and their families.

Child Aid work across Eastern Europe, providing support to disadvantaged children. Their mission is to turn the children’s lives around. They work to prevent families breaking down, to support abandoned or vulnerable children, encourage education and play, and to change attitudes to disability. Martin told me about the lack of inclusivity in Moldova, and how desperately those with disabilities need access to mobility equipment in order to increase their participation in the community around them. Often disabled people are kept at home, as the community and environment simply isn’t accessible. Disabled children don’t typically go to school. This means that their predominantly female caregivers are unable to work and are struggling to live off around $5 per day.

During our discussions I mentioned postural management, which led Martin to tell me about an ongoing project he was working on in Moldova. At present there is no university qualification for occupational therapy in Moldova. Dr Diana Covalciuc, a pioneer of children's rehabilitation in Moldova, had recognised the need and was implementing a training package to introduce the concept of occupational therapy to therapists, the university, and government health officials. She hopes that this is the starting point to developing a university course for occupational therapy in Moldova. The project is funded by the Rotary Club in collaboration with Child Aid to Eastern Europe.

Martin was looking for someone to provide peer to peer training in the role of occupational therapy in postural management - and I was lucky enough to be in the right place at the right time!

Covid and the outbreak of war in Ukraine delayed us delivering the course as quickly as we had wanted to. But eventually we were able to start planning our trip to Moldova. We sent questionnaires to the delegates, to explore their current roles and their level of knowledge and experience of postural management. From this it was possible to plan our training content. The course was going to be delivered at a conference centre, with our material translated into Romanian by our wonderful Moldovan doctor colleague, Natalia. I was a bit apprehensive about my every word being translated, but Natalia was cool, calm and great fun.

Armed with 2 days' worth of presentation materials, group work, exercises and case studies - we flew to Moldova. Diana had kindly arranged for her devoted husband (himself a retired pioneer of children's medicine in Moldova) to deliver us some of the donated postural management equipment to use as part of the training. We were also lucky enough to have been donated a recycled Neater Eater by Neater Solutions, which provoked some very productive discussions about posture and function. The therapists were delighted with the Neater Eater and have a list of clients they are hoping will be able to access a loan.

The course went by in a heartbeat. Our Moldovan colleagues were very receptive to discussions about function and engagement, and how this needs to be balanced with all the other aspects of postural care. Their dedication and determination to provide the best for their clients blew me away. The disparity between what is available in Moldova and what we have in the UK is huge. Our colleagues spoke of the lack of equipment, limited community acceptance, and absence of support systems for children and their families. There is much work to be done, but Diana and her fellow pioneers are doing their best to bring about change in Moldova.

After the course, we were lucky enough to visit a school in Valcinet, and their attached after school club, Esther House. Times are hard in Moldovan villages, with young people leaving to study and work in the cities. Families are reliant on low agricultural wages and sometimes a very small benefits payment. Alcohol dependence is a problem, leaving the children needing external support. The headteacher lovingly cares for all of her pupils, while also running Esther House. Both establishments are safe havens. The adults treat the children with the greatest of respect, the children return this respect, and both children and adults have great fun being together. If you’re looking for a charity project to donate to, this is a very worthy cause.

We were also lucky enough to visit the Tony Hawks Centre in Chisinau, where Diana runs her children’s’ rehabilitation service. You can read more about this here: http://www.tony-hawks.com/philanthropy/ We were able to meet some of the young people they serve, and spent time supporting some of the therapists there to provide clinical interventions to address their postural management. The lack of equipment available to offer children and families was really brought home to us during these sessions. We learnt fast, however, that Moldovans are “can do” people. Parents are willing to adapt what they have to the best of their ability, for example re-sewing buggy straps, extending footplates, creating wedges from pool noodles… As I’m sure you can all imagine though, there is a limit to what can be achieved if the equipment doesn’t meet the need. More equipment is desperately needed out in Moldova and Ukraine.

Q: How often have you undertaken the training out there?

We have completed the 2-day initial course and are hoping to return to provide some working sessions in clinic with the staff there in the near future.

The occupational therapy in Moldova project is ongoing, with other occupational therapists around the world lending their expertise to the delegates for short courses. I can honestly say, they will have a wonderful time working with such a dedicated, passionate and caring collection of therapists.

A: What are your future plans/next steps as a therapist?

Having been to Moldova and met the people there (and sampled their fabulous wine!), my aspiration is to return and support Child Aid’s project as much as possible. I encourage interested occupational therapists to get in touch if they think they can offer their support.

Charlotte and Holly (physiotherapist) lecturing to the delegates.