Monday, April 4, 2016

re * ha * bil * i * ta * tion

Rehabilitate - to bring to a condition of health or constructive activity, says Mirriam-Webster.  Or the Latin translation is "to make fit again."

One of my favorite books on transformational development, When Helping Hurts, sandwiches rehabilitation between efforts to alleviate a crisis and development.  Efforts to provide essential elements to sustain life are included in crisis alleviation.  We hear about these efforts whenever there is a weather related catastrophe or disease outbreak or even war.  WGM staff in Hungary responded to the crisis of the migrant movement through Europe precipitated by the fighting in Syria and the surrounding area.  WGM has also recently helped provide food to victims of war in the Middle East.

Development on the other hand is the process of creating something or advancing it.  When it comes to communities it's the process of taking a community where they are at . . .  and if they have suffered a trauma they will have first gone through the crisis stage . . . then rehabilitation to get back to their baseline . . . and then building from there.  

In my last blog post, Down River, I made reference to a hiccup in this continuum.  After the war in Uganda when life had settled down many NGO's and the government continued responding as if the situation were still in crisis mode.  Continued giving after the crisis stage had passed helped create a dependency syndrome.  This is common in areas that have been affected by war.  As we engaged with a community we saw that their expectations to receive hindered them from doing what they could do for themselves and reaching their fullest God-given potentials.

That may or may not make sense to you.  In the past 2 months I've seen it illustrated so well that I wanted to share this personal experience with you.  I bet many of you can relate to this too!

On January 21st while at home in Nairobi I received a text from my sister that my Mom had fallen and broken her hip.  January 22nd saw me on a jet plane to Orlando to be with her and my Dad.  I was already scheduled to return to the US to attend several meetings so this worked out quite well.  Mom had surgery and I was with her 48 hours later.  Not bad!  The combination of anesthesia and pain meds had her a bit loopy.  She was in pain of course and did not want to move much at all.  When her meal trays came I quickly popped her straw out of the wrapper and set everything up so she could get at things easily. You might have thought I was an Ensure saleslady - pushing the highly nutritious drink at all opportunities.  When Mom needed the bedpan I helped the nurse roll her, I took her TED stockings on and off, etc. 

Honestly Mom wasn't doing much of anything during those days in the hospital - and that was OK.  I would equate Mom's hospitalization and her dependency on the staff as a typical crisis period.

Times of crisis require stepping in and doing for people the things they can't do for themselves.  I'm reminded of the time a few years ago when there was tribal fighting in the town where we were working in South Sudan.  Half of the village was burned down and hundreds of families had nowhere to live and nothing left from their homes to take with them as they made makeshift homes in the bush.  We let you, our champions, know about this need and through your kindness we were able to give each family some cooking pots and a tea kettle. Giving food, blankets, and housing are a few examples of what is needed during a crisis.

After 6 days in the hospital Mom was stable enough to be moved to a rehabilitation facility.  Making good progress she soon mastered the one legged twist - aka transferring to a wheelchair while she was non-weight bearing on her affected leg.

Days and weeks of therapy led to partial weight bearing.

 Then 50% weight bearing on her affected leg resulting in - walker time!

As her surgeon has increased her activity Mom has embraced the challenges depsite the pain. 

This has been a fun phase - Mom can do more and more each day.  She has kept busy sunning outside, playing the piano, knitting and keeping up with email! But she still can't do everything and what she can do - well, sometimes it takes her a long time and I can tell moving hurts.  

When she gets into bed from her wheelchair her left leg moves up onto the bed quite easily but that right leg. . . . not so much.  It kind of dangles in mid-air as she overcomes the discomfort and mobilizes her strength to pull it on top of the bed.  But she does it - by herself, slowly, without any help from me.  I could continue lifting her legs up onto the bed like I did in the hospital, it would surely be faster, but as long as she can do it I'm going to let her.  What do you think:  mean daughter or daughter who is interested in making Mom fit again?

The other day I was there when her supper tray was delivered.  The person delivering the tray was new to Mom's wing and didn't really know Mom.  After setting the tray down she took the lid off the plate, unfolded the napkin and opened Mom's milk carton.  Wooa, wait a minute.  I thought to myself, Mom can open her milk carton!   She doesn't need help setting up her tray - she just finished playing the piano!!  As she ate I shared with her the angst I felt seeing someone open her milk carton.  I know the aid was only being helpful but seeing someone do something for Mom that she could do for herself looked like a step backwards.

My hope, prayer and goal is that after rehab Mom will be able to return home and soon do many, if not all, of the things she used to do.  And her time in rehab is to help her regain the skills to do all those things.  If the staff are doing things for her that she can do for herself that will affect her in several ways.  First, she could get used to being waited on - hey, we all like that.  I'm certainly not going to deny that I don't like being waited on!!  Second, she might feel like she can't do things for herself and won't try as hard, seeing herself as a dependent patient.

You might be asking yourself where this is going.  This scenario can be compared to working with disadvantaged communities.  This is sometimes seen during short term trips and/or when someone swoops into a community with 'help' and then swoops out, never really getting to know the people they're there to help.  It's all too easy to assume a community is not able to do for themselves, or can't pay for services, or can't organize for something.  It's so much easier, and faster, for us to just do it.

So easy that yesterday Mom caught me.  Her roommate motioned for me to come over to her bed and she asked me to turn her TV off.  So I turned her TV off.  Mom laughed and told me she thought maybe I should have shown her how to turn it off herself!  Touché!

Although Mom's making great gains with the walker while putting first 50% weight on her affected leg and then later full weight bearing she's not been given permission to walk outside her room. I'm happy to wheel her outside to get a bit of sun, because she can't get outside through her own steam. But for what she can do I'm happy to let her do it - even if it takes 10 minutes to get that sock off! She won't be experiencing God's fullest intentions in her life if she isn't doing all that she is able to do. I don't want to rob her joy of doing it her herself!

This period inbetween a crisis phase and a growth stage is tricky.  Trying to be helpful but not too helpful.  I don't think there can be any hard and fast rules as each situation is different. So here is a reminder to myself after being with my Mom for almost 2 months . . . Assess what stage of need people are in before rushing in with help.  And keep assessing how much help is needed.  Luckily Mom is able to do new things each day.  

Do you have any rehabilitation stories from near and far? I'd love to hear them.  Did the people you were helping reach their God-given potential at that point in time?  

Rehabilitation - the process of making fit again.  I'm trying to keep the end goal in mind!

Shared with permission from Carol Phillips, my Mom, who is doing a remarkable job of rehabilitating!