Days 25 and 26

Tuesday

Tuesday wasn’t a great day. Many frustrations and not enough ‘good bits’. That said, it was the only day that i haven’t enjoyed in my time here so i can’t really complain. I arrived at the Centre to find we had another powercut. This meant no dancing to start our day (I think I get as much benefit from dancing first thing in the morning as the young adults do). We also had to rethink our next activity as while the activity didn’t require electricity to complete, we had not photocopied the sheets of pictures of daily occupations needed. So, the group spent some time playing outside and then drawing. Not the most imaginative of mornings. The power returned before lunch and the manager, my translator and I spent another frustrating hour trying to get the daily occupations task ready and contending with a photocopier that would only produce the faintest images from the print we provided.

I left work after lunch for my Romanian lesson, and the frustration continued. I then travelled back to my accommodation on a trolleybus that firstly disconnected from the overhead cables, then broke down (in a lovely spot right in the direct sunlight, though the driver did at least leave the doors open, not that it provided much relief from the intense heat), once moving again got stuck in traffic, and finally got wedged behind another trolleybus that had disconnected from its cables. When I arrived home after 6pm I was hot, tired and a little bit fed up! Thankfully some food, a shower and a trip to the gym cheered me up.

Wednesday

What a difference a day makes! I appear to have caught a cold. So that, combined with a slight ‘hangover’ of the frustrations from yesterday, meant that I felt a bit under par when I started my day. I then got the news that my flight home had been changed by the airline and instead of arriving at 7pm on Friday it will now be landing at 11.30pm. At this point I did wonder if the frustration theme was set to continue but somehow, mindfully, I got on with my day.

I spent my whole day working individually with the 5 young adults in attendance today. One by one we talked through their daily routine and made a poster of the times they engage in all of their important occupations. The aim was to create a focus on independent personal hygiene with the hope that an individual poster might be used as a prompt sheet at home. It gave me a great insight into their lives and also, due to having a translator, I got to hear a lot more of their conversation that when I’m working with my supervisor who only has time to briefly summarise the content – having a translator is definitely a ‘pros and cons’ type experience.

I was struck by how similar each person’s day was. The times varied due to the person’s proximity to the Centre, but the nature of occupations participated in was so similar. Part of this is cultural. People in Chișinău do lead lives that are full of domestic activities; daily trips to the market for food, food preparation, eating as a family and watching television together. But, I imagine that most young people here would have a bit more variety and independence in the occupations they participate in and I suspect people with learning disabilities experience significant inequality in the opportunities they have to choose how they spend their time. Their daily routines seemed more akin to those of a young child who is entirely reliant on their parents and there was an absence of time spent with friends or in participating in any leisure activities other than television. I’m not sure why this surprised me, it certainly fits with my observations of the expectation for people with learning disabilities to be hidden from society, but I suppose just seeing it in black and white really confirmed this for me. I certainly feel very glad that they attend the Centre and experience the social interactions and range of activities available to them there.

Despite feeling a little sad about the above I valued working with each person today. It was an absolute privilege to get that time with them as normally we are trying to run group activities. I can’t believe tomorrow is my last day on placement. Working with everyone out here has been the absolute highlight of my trip. I also feel so lucky that I can get so much personal benefit from ‘doing OT’, I’ve had many days on placements where I have felt tired, sad or grumpy at 8am and then found my mood has lifted the minute I start working with people. I feel very hopeful about, and lucky to have, a career full of ‘doing OT’ ahead of me.

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Days 23 and 24

Sunday

I rounded off my fourth and final weekend in Chișinău with a visit to the stunning Organ Hall to attend a concert given by the capital’s youth orchestra. They were fantastic. In particular their fifteen year old piano soloist was quite remarkable, she performed with the maturity of someone much older.

While the quality of the performance could have permitted me to believe I was at a concert in Vienna there were certain moments that reminded me I was most definitely in Chișinău…

Entrance to the concert was free and so when the doors opened there was a mini stampede for seats. The other volunteers and I were not quick enough to get a seat but we soon noticed people bringing in chairs from the rooms outside the main hall. We joined them and added our chair to the end of the ‘reserved’ 3rd row. Fortunately for us, the health and safety attitudes that had prevented baking at the day centre were not adopted here; no problem at all with blocking the aisles!

We were sitting by the official cameraman who was using a Sony video camera that probably dated from the 1980s. Definitely not digital and the battery pack had to be changed three times during the performance (might I add the batteries were about the size of a house brick).

The ‘encore’ baffled me slightly, too (they have a different name for it but I didn’t catch it). After the final piece was played the house lights went up and there was lots of applause. The encore was called for, along with a type of uniform handclap, and the orchestra obliged. And then a second encore was called, this time the orchestra responded with my favourite piece from ‘Swan Lake’. More applause. And another encore. We sat through 5 extra pieces, with people gradually leaving after each one. I’m not sure when the poor orchestra were finally allowed to stop, I think the appreciative audience were in danger of exhausting their repertoire!

What else? Oh yes, the heat! It was 32 degrees outside the venue and about the same inside. I’m definitely glad I wasn’t playing the clarinet for 2.5 hours.

Monday

My final week on placement is going to be a little different as my supervisor is on annual leave. Consequently I have a translator to allow me to communicate effectively with both staff and clients. It was a strange experience. My translator is lovely and someone I’ve got to know throughout my time here. I was slightly apprehensive about taking an ‘outsider’ to work with me, given that she wasn’t familiar with learning disability settings. I needn’t have worried as she fitted in perfectly, joining in with our cleaning and dancing activities – all ‘above and beyond’ her duties as my translator. She admitted to me as we left she had been nervous about being there today, simply due to not being sure what it would be like to be around people with learning disabilities. She then said that she’d really enjoyed it and liked the centre. I was so pleased that she’d had such a positive experience, especially because people in Chișinău who don’t work in healthcare, and even many who do, are unlikely to meet people with learning disabilities as they are so protected and almost ‘hidden’ here.

As for the effect of having a translator on me, definitely a mixed experience! It afforded me much more autonomy as I wasn’t conveying my ideas to a supervisor who then implemented them in the way she imagined, given that she was often involved in leading the activities too. But, in a strange way it also reduced my independence. When I worked with my supervisor I’d often find she disappeared when I was starting a group session and so I figured out how to run the session and communicate with lots of non-verbal gestures and demonstrations. Today, however, I was ‘on my own’ but had someone to translate my intentions/questions/prompts. While both I and my translator were clear on what was happening I think for many of the clients it appeared as if my translator was the one running the session. She was the one they were hearing their instructions, encouragement and feedback from, despite them being my words. While I was able to complete a more complex intervention today, I almost preferred it being just me and them and few words. I hadn’t expected that.

Due to our low number of clients this week (seven today), I grasped the opportunity to do some individual assessment and work. I introduced the clients to my tablet PC and we spent some time working through a variety of logic games, artistic apps, puzzles, music games and sports games. They were so engaged, I suspect because both individual work and tablet use was different for them. I hoped it would engage them well as many of them enjoy games on their ‘phones (most have a ‘phone but they are pretty basic, non-smartphone types) and they do not have access to computers at the centre. Chișinău is a city that is very rapidly catching up with the technological age, with free WiFi in the many public parks, so it felt relevant as an occupation that will be becoming increasingly prevalent in their society. It also allowed me to provide a range of app choices to suit their interests and the areas I thought might be useful to work on.

Tablet use is great for being able to show a range of options and letting the client pick the games they want to try. Happily, by choosing their own games they all seemed to pick things that they were interested in AND addressed the skills I thought they could do with working on. I’m not sure if that was coincidental or not. I suppose allowing that element of client-centredness ensures that the ‘meaning’ is present. It also means that the right challenge level is found as the client doesn’t pick a game with no demand for them. As for how it worked that those with good fine motor skills picked the games most challenging for process skills, I’m not sure.

I’m so impressed with the types of apps out there. I only have free apps on my tablet and yet I managed to find so many options that are also age appropriate – something which I have noticed is a challenge here, in terms of the printed materials available at the centre.

While I loved the app session it certainly has prompted me to reflect on the challenge of ensuring client-centredness due to the language barrier. I’ve done my best to adapt tasks to suit individual’s strengths and needs, their interests and their engagement/participation levels. But so much of it has been supposition and guess-work. If I had longer here I’d definitely work on ways of assessing and identifying goals and priorities with, and not for, the young adults. It definitely hasn’t felt comfortable for me to work this way (which, ultimately, reassures me) but I think adopting a different approach would be a considerable task. Not only would I have to work out how to do it, which probably wouldn’t be that hard, but I think I’d have to do a lot of explaining of my reasoning and theory to all the staff as this would be a very different approach for them. Part of me thinks ‘why didn’t I start this in week 1?’. However, I didn’t and I know I did the best I could at the time. I also am not sure it would have been achievable in a month long placement, so perhaps incorporating small glimmers of client-centredness is Good Enough. Who knows? I’ll keep reflecting.

Days 21 and 22 – Cricova Winery

Friday

Yet another sunny day in Chișinău. In fact, in the time I’ve been here there has only been 1 heavy rain shower amidst unbroken sunshine.

Today was the first day of the bus driver’s holiday, so we had 6 young people in attendance, compared to our usual 25. We began the day watching some educational videos about Great Britain and Moldova, they were both in Russian so I didn’t understand much. Although the video about Stonehenge was accompanied by music played on bagpipes…

We then began our work on daily routines, with a particular focus on self-care routines in the morning as some of the group have difficulty with maintaining their personal hygiene. This was a challenging session for me, as it was something I was keen to work on but was much harder to do without good language skills compared to the more practical tasks I had been leading. Fortunately my supervisor was able to lead the discussion while I assembled the poster of the agreed routine. Throughout the task I was beating myself up a little as my intention had been that each person would create a morning routine poster, unique to their own habits, that they could take home as a reminder. I’d thought my idea had either been lost in translation or ignored by my supervisor but it became apparent that Monday’s activity will be me repeating the task but on an individual level. This scenario highlighted a definite difference in my UK and Moldovan placement experience. A lot of the time I have to ‘go with the flow’ a lot more, as I do not have the luxury of understanding all the conversation between staff members and clients in order to know what’s happening!

At lunch time the staff team were very concerned that I eat a good lunch, as I was going to visit a winery and partake in some wine tasting in the afternoon. They had a typical Moldovan meal for me with Borsch, Stuffed Peppers and lots of bread. It was all most tasty.

I left placement early to go on the aforementioned trip. On my way I visited the post office to post some cards home. They cost only 22p per airmail stamp. Quite amazing given the current UK internal mail prices. I’ll be interested to find out how long they take to arrive in Marea Brittanie!

Then, to the winery! Cricova winery is one of Moldova’s most famous and located just outside of Chișinău. It’s known as the underground wine city as it consists of a maze of roads and rooms 60-80m underground. The underground world allows the wine to be stored in perfect conditions for its maturation. The temperature is about 14 degrees Celsius and humidity 98%. I wished I’d brought my one and only long sleeve hooded top with me as it was a big temperature gradient to enter the tunnels from the 32degrees outside. We were shown around the winery from our mini train (connecting golf cart style trains). In particular the process of creating the sparkling wine, for which they use the same traditional method as in Champagne, was very interesting. We had a tour of the wine tasting suite. This comprised a number of themed rooms, all 60m underground but with features like a real wood burning fire, or windows that appeared to have daylight. We finished the tour in the underwater themed room (an interesting theme for a landlocked country). Here we tasted a white, rosé, red and sparkling white wine. They each had a unique and distinct aroma. The rosé smelt of black current and other forest fruits. My favourite was the sparkling wine, of which I was given a second glass. Noroc!

Cricova was fascinating and so different to any other experience in Chișinău so far. I suspect the reason for this was simply money. Every other tourist type attraction I’ve seen so far has been wonderful, but the challenge of low visitor numbers and very tight budgets has been evident in poor quality lighting or run down interiors of the attractions. Even the monastery that I visited on Wednesday, although beautifully maintained and cherished, used basic items for its construction. There is clearly money in wine, as the quality of the furnishings and vast areas of marble demonstrated. It was beautiful, but ever so slightly incongruous with what I’ve seen of the country. As we hurtled around the dark tunnels on our wine train I also had a mental image of scenes from Harry Potter, and also, perhaps more disturbingly, the tourists visiting the Volturi in The Twilight Saga books (for the uninitiated the tourists are ushered around a beautiful, marbled, Italian building before becoming the next meal for the Volturi vampires). It was brilliant! I also loved how each tunnel was named after a Cricova wine. I can’t remember the names of those unique to Cricova, but we certainly travelled along Strada Cabernet and Strada Sauvignon.

Saturday

It’s only 3.30pm here so perhaps a little early for my Saturday entry, but never mind! This morning the other volunteers and I visited the ‘National Museum of Etnography and Natural History’ in Chișinău. Although, I’d somehow missed the ‘and natural history’ part of the description before arriving and so my inner geologist was incredibly surprised and pleased to get to view Moldova’s extensive collection of rocks and fossils! There were some awesome exhibits of trilobites and ammonites discovered, as well as corals and brachiopods from hotter and wetter times. I particularly enjoyed being able to see the soil types from various parts of the country and the richness of the soil, that allows for extensive agriculture here, was evident. We also saw exhibits of national clothing and important figures in Moldovan cultural history.

I’m planning to have a mostly relaxing weekend as I’m feeling pretty tired now, although will be attending a concert by the National Youth Orchestra tomorrow. It’s hard to believe that I’m about to start my last week here. I feel very sad about leaving this placement as there’s so much more work I could help with, although I am looking forward to getting back to having my own space and not being a guest any more!

Day 20

Thursday

Today was brilliant, we didn’t do anything out of the ordinary but it was a great day for my learning. Although, it has dawned on me today how much I miss having an occupational therapist supervisor with whom I can reflect on my observations, particularly of analysis of motor and process skills and motivations for occupation. At least I have this blog, and I suppose it encourages me to think a little for myself.

We began the day with a craft exercise that I had devised. It involved each person drawing around their hands on a foam sheet of ‘paper’. They then cut out the hand prints and joined them together with a paper ‘double concertina’. The whole task was quite challenging as it required lots of bilateral movement and use of the non-dominant hand to draw the second hand print. I found it fascinating to watch – every young adult seemed to find or part of the task easy and another more difficult, but there was no uniformity in which part of the task was hardest for them. Some I expected to need lots of help to make the concertina, but after a quick demonstration they picked it up straightaway. Others needed continuous reassurance for that part but were easily able to draw their handprints and assemble the final item. With everyone a forward chaining learning process seemed to work, some liked to watch me demonstrate on my ‘one I prepared earlier’ and then replicate independently, whereas other preferred to have some assistance to start each part of the task before completing it themselves. As I say, it was fascinating, but I did have a moment of just wanting a more experienced occupational therapist there watching so that I could discuss all that I was trying to analyse.

The second part of the day was a slightly surreal leaving party for me. Although I have a week left on placement a lot of the young adults will not be in attendance after today, due to the bus driver’s holiday that I mentioned previously. I was given my final report/letter about my placement as my supervisor is also on holiday next week. It was lovely to read, but in some ways I was surprised that things like having good communication and being knowledgeable were praised, as I’ve wondered about the level to which my skills have crossed language and cultural barriers.

The group activity this afternoon was a drawing teamwork game. Everyone started with a blank piece of paper and began a design. We had music playing and when the music stopped we passed it to the person on the right who added their design (this worked well until we had a power-cut!). Eventually each person ended up with their own picture back, but with the contributions of 19 other people. I was very touched to be given everybody’s drawing as a leaving gift while they kept the one I had begun as a memory of my time with them. Definitely a *goosebumps* moment as each person presented me with their picture and shook my hand.

My supervisor and I then made some plans for tomorrow’s small group. We want to do some work on personal hygiene and so I suggested making a poster about each person’s morning self-care routine. Finally, I’m managing to incorporate some occupations other than leisure and education (productivity).

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Day 19 – Mănăstirea Hâncu

Wednesday

Today was our long awaited excursion to Mănăstirea Hâncu, one of the largest monasteries in Moldova, located about 40km outside of the capital. This was my first trip into the countryside and I found the rolling hills and endless forest very beautiful. Despite the heat of 20 people in an old minibus the journey was very pleasant and I enjoyed every minute. We arrived and the girls donned their headscarves while the boys removed baseball caps and we approached the monastery. Hâncu is home to at least twenty nuns and consists of a number of beautifully kept yellow buildings in the traditional Greek Orthodox style. The buildings are surrounded by the most vibrant and colourful selection of flowers that I’ve seen here and while we were there the ongoing nature of the upkeep of the land by the nuns was evident. The main church building is currently undergoing renovation and its access by some rickety planks of wood was a little challenging for some of our group. However, when it is finished it will be stunning. The nuns were also working in the grounds with their home produced vegetables preserving them in jars for the winter ahead. This is very common practice for all Moldovan households, just the scale of the operation here was much larger. The nuns also have a considerable amount of farmland where they produce all of their food. the monastery is entirely self-sufficient. We then walked to an area where a natural spring water flowed, which is known for its holy properties. The group seemed to relish drinking and bathing their hands and faces in the ice cold water. We enjoyed a picnic lunch nearby before making the journey back to the centre.

Throughout the trip I was, again, pleasantly surprised by the behaviour of our group. I suspect it’s a lot to do with the cultural importance of religion and monasteries but everyone was very quiet and respectful when moving throughout the grounds. One of the young male clients, who has limited verbal communication methods, understood that he needed to reduce the volume of his speech and swapped to using more hand gestures to express his wishes.

A most pleasant day, if a little tiring. Just uploading some of the photos of the incredible buildings at the monastery. It really was something so very different to I have ever seen before and a definite privilege to get to go there as part of my placement.

Oh, and I’ve discovered the most delicious Moldovan chocolates. The most famous chocolatier here is ‘Bucuria’ and a particular chocolate, ‘Favorit Plus’ is definitely a new addiction. It is a dark chocolate shell surrounding a milk chocolate/praline type filling and a whole but in the centre. This might thwart my plans to come home with a much lighter rucksack that I travelled here with!

Day 18

Tuesday

Today had a slightly different start to our planned activity. I arrived and was asked to run a Latin dance exercise group. Fine. I had music and willing participants, but unfortunately no change of clothes for myself for afterwards – 45 minutes dancing in 28+ degree heat is hot work! Oh well. I then learned the reason for the change of plan. The centre was being inspected by the Directorate of Children’s Services (again, an indication of attitudes to learning disabilities in Moldova: our youngest client is 17, oldest 45 an most in their twenties…) and our planned activity of cooking is not permitted by said directorate. I had to hide my *jaw drop* reaction and find out why, given that a principle aim of the centre is to promote independent living skills, an aim which is supported by the aforementioned Directorate. Apparently it’s due to risk. It’s funny, I’d wrongly assumed that things in Moldova would be a bit more relaxed regarding Health and Safety. The centre’s staff have food hygiene training and the oven is located in an area off limits to the young adults. The latter fact originally frustrate me as I wondered how cooking skills would be worked on, now I realise that a cooking group would only involve the preparation of the food but not the cooking. And even that is prohibited.

The inspector left and we continued with a day full of planned activities. As to what they entailed, I couldn’t possibly comment…

I left slightly early to complete another Romanian language lesson. I’m making progress, albeit slowly. I keep going to shops and restaurants to test out my skills, often the staff members speak to me in English before I’ve even spoken (no, I am not wearing clothes with a Union Jack on them). Other times I start conversation in Romanian and they respond in English! I think it’s just the culture here to be incredibly helpful and welcoming to foreigners (despite tourist being pretty rare here) and it is a requirement that people here learn a language (often English) all through their schooling. It’s lovely, but not helping me learn! Ironically, the only person who conversed with me in Romanian today was a man selling postcards in the tourist souvenir market.

Day 17

Today I gained real insight into the most important role at the day centre that I’m working at. The one person the centre cannot manage without is the driver. The manager, the medical assistant, the social assistants, the accountant and the cleaner can all take holidays and the remaining staff will cover their duties. However, when the driver takes a week’s holiday this Thursday our client group will drop from 25 to the 5 young people who do not rely on being picked up by the centre’s minibus. Additionally, we will have no excursions, no trips to the park and no weekly visit to the church. I’m guessing they’ve worked out a way to get the lunch delivered for the clients as it’s usually picked up by the driver, domestic assistant and 3 of the clients each day. It’s bizarre. The poor old driver is entitled to 4 weeks holiday per year, but reluctantly takes 1-2 weeks as he doesn’t like to leave the young people without access to the service. There is no alternative and no provision to provide a temporary replacement. Definitely a real moment of understanding differences in how services run in Moldova, compare to the UK.

Anyway, once I got my head around this news we got on with our day. We started with our Latin dance exercise. I had a little ‘squee’ moment as I noticed how much the group were improving their coordination. One young woman, who really struggled to process how and when to transfer her weight to complete a ‘box step’ was happily dancing along in time. We spent some time at the end of the structured activity having each person come up to the front and either demonstrate an exercise for everyone to copy or just having some fun ‘freestyling’. I enjoyed it so much. A week ago I introduced something new to them and now it feels like it’s really grown and developed into their activity.

At lunchtime I was treated to lunch out by the director of the company that organised my placement. It was very nice, but a bit surreal to be able to disappear off for a Moldovan 3 course meal (soup, main and fruit compote) in the middle of my working day. I suppose that’s the difference between being on placement in the UK as part of my occupational therapy degree and being here as a volunteer that they are so grateful to have.

This afternoon was spent completing a craft activity with a small group. We used double sided sticky tape to complete mask kits and I was told this was a material unfamiliar to them. I decided to step back and just ‘see what happened’ for a moment. One group member worked out how to use the tape independently, two required a demonstration and then were able to use it and the fourth found it difficult to create a strong pincer grip to manipulate and peel the tape, but was able to use it with minimal assistance once the ‘fiddly bit’ was done. My instincts had been to make the task clear from the outset, but I think it was better to let them explore and work it out for themselves. It certainly gave me more insight into their abilities to problem-solve and I made sure I was able to respond with a demonstration before they became frustrated.

The day also involved some planning for our new, driver-less, schedule and translating my recipe for fairy-cakes from English to Romanian. Hopefully we haven’t made any crucial errors. Time will tell and I aim to be blogging tomorrow about the delicious cakes we created!