Occupational therapy, disability awareness and wheelchair access in Samoa

Sally Baker, Samoa

Samoa is a small, independent nation consisting of2 main islands, situated in the South Pacific Ocean. It is a country which has a friendly, village-dwelling population of about 156,000 people. After adding a copy of the Australian Access Standards to my ever-growing pile of luggage, I set off for this paradise in the Pacific.

On arrival, I counted 300 churches during the 40 minute drive from the airport to the capital city, Apia. I was soon to discover that churches are often built on hillsides, in order to be closer to God, and therefore the number of stairs to get to the interior was often too many to count. Given that a large proportion of the population contract Type II Diabetes at an early age, I was beginning to realise the scale of the problem I was dealing with.

Much of my first couple of months were spent meeting everyone and anyone involved in working with people with disabilities; church leaders, leaders of the women's committees, village Matai's (or chiefs), people with disabilities themselves, government officials, and people in the media. During this time I attempted to gain an understanding of the needs of people with disabilities, and what the community leaders were able and willing to do to improve access so that their disabled village members could have equal access to their spiritual needs.

From here, my project went in many different directions. I developed an "access checklist form" to be used by the pastors of all the churches to assess the suitability of their church to wheelchair users. I met with church leaders and provided them with copies of an "Access Package" which had been translated into Samoan, and outlined simple and cheap ways for Pastors and community members to improve access. I ran disability awareness workshops at the different church training colleges for Pastors and their wives, who often oversee the welfare of village residents.

I also found myself in a range of other roles: consulting on access issues for the Lands Survey and Environment Department; working one day per week at the National Hospital providing rehabilitation to stroke and gout patients; conducting access audits; assisting in the formation of a national disability advocacy group; involved in Samoa's first United Nation's International Day for the Disabled; and a committee member for the National Paralympic Team. In addition, the national press became interested in the project, and ran an "expose" on the state of the footpaths and buildings in Apia.

Of course, it wasn't ALL work, and I consider leisure to be just as important an occupation as productivity. When not thinking about ramps, I spent lovely moonlit evenings at the most tropical beaches around, took in the local culture in the bars, and shared limitless meals of tinned corned beef and pig, taro, breadfruit and bananas with Samoan people, who were generous with their hospitality.

While the process of adapting one's skills and prior knowledge to a completely different and sometimes confusing context is undoubtedly hard, I am very glad to have had the opportunity to do so. I think this experience has showed me the diverse and lateral things that occupational therapists can do, if they so choose. I believe that there are big opportunities for OT's in development, as we are trained to establish what the needs really are, share knowledge and skills, and adapt our practice according to the needs of the client. This is what development is—the sensitive and culturally appropriate sharing of knowledge and skills which have been determined by the client or group as a real need, so that the client or group can take those skills and use them independently.

I've been back 6 weeks, and plan to return to Samoa to work in occupational therapy in the hospital!