Sustainable OT in the Developing World
By: David Thomforde
Image description: David Thomforde is standing outside in front of a bush and a bricked building. David is wearing a blue-green polo and smiling.
David Thomforde grew up in Italy and always wanted to live and work around the world. To gain experience, he volunteered for 3 months at Projecto Projimo, a small rehab village run by people with disabilities in western Mexico. David Werner compiled the workers’ experiences and ideas in the book “Disabled Village Children”. Thomforde also spent 3 months at NORFI, a community- based program in Bacolod City in the Philippines. David’s experiences led him to think about how occupational therapy practice could be more sustainable by using local and/or otherwise discarded materials. In Mexico, a boy with muscular dystrophy and weak shoulder muscles was able to eat independently when his arm was placed on a rocker made from a crescent-shaped piece of Styrofoam. He was able to hold a spoon that had strips of bicycle tire wrapped around the handle. The program received large quantities of used rehab materials such as wheelchairs and walkers but when they broke, they could not be repaired so the staff developed procedures for making items locally.
Thomforde continued his sustainable OT focus as he lived around the world. In the Comoros Islands, he used soda cans to make rattles and little cars that could be used for infant stimulation.
David taught community workers and OT students in Uganda to make devices such as knee pads (for people who had to crawl) from pieces of car tire, and dressing sticks from forked branches. In Uganda, the challenge was finding materials that were no longer wanted; the people were poor and every box, every scrap of cloth or piece of metal was used until it fell apart.
In Paraguay, Thomforde developed two courses for rehab workers. The first taught them how to make boards from multiple layers of cardboard glued together with wheat flour paste. These were cut like wood and were very strong when dried under pressure (google “Appropriate Paper Based Technology”). The boards were fastened together using strips of cement bags glued with the same wheat flour paste. With this technique, the trainees built supportive seating for children with cerebral palsy; as the child’s condition changed, the chairs could be easily adapted. The second course was on making static splints. Trainees learned to carve Styrofoam to fit the contours of the individual hand or leg and fastened these to pieces of plywood. The trainees made resting hand splints, wrist cockup splints, anti-spasticity splints, thumb post splints and foot ankle orthoses. These techniques were well adapted to Paraguay because people were well off enough so cardboard, wood and Styrofoam from packaging were available yet the majority could not afford imported thermoplastics.
In India, Thomforde worked for Handicap International, a French organization, providing technical support to several different projects including rehab centers, an inclusive primary care project and a program teaching sewing skills to women with disabilities. Handicap International also responded to hurricane relief needs by providing devices lost during evacuation. Thomforde advocated for training local carpenters to make wooden crutches but the people preferred the aluminum crutches which international aid groups brought in; these looked good but quickly broke in the rough terrain and could not be fixed by local craftsmen.
Thomforde also incorporated the use of recycled materials into his leisure activities; while working for a rehab project in Sierra Leone, he found a canoe that had been damaged during the civil war. The rehab project was making prostheses from plastics and had many scraps. He heated the scraps and applied them over the holes in the canoe, restoring its usefulness.
In between overseas jobs, he worked for home health agencies. He had clients put away dishes as a functional activity that improved arm strength. To improve figure ground awareness, the clients sorted silverware; no special equipment needed. By filling bottles with water, he made weights which could easily be made heavier or lighter as the client’s strength changed.
It is hard to encourage people in the USA to make their own therapy devices since much of it is complicated and government programs provide them at no cost. DME reuse is complicated by issues of liability and sanitation. Yet even in the USA there is a place for sustainable OT. For example, glue a plastic saucer to the bottom of a cup and you have a non-spill cup or screw a hook into a broom handle to create a dressing stick.
David is retired from clinical OT. He advises an OT university program in Guyana and a virtual mentoring program for OTs from developing countries. Sustainable OT is still his passion.