Saying Goodbye to Romania

When we originally planned our trip to Romania, we decided to stay and extend our trip. The funds that were raised through your donations were able to fund our mission including our airfare, translators, and supplies for the orphanage only leaving our hotel stay for our own personal expense. We were then allowed the freedom to use our own personal funds to enjoy some sightseeing during our days off to help us transition and decompress from the emotional week we had prior. Saturday we visited the ASTRA museum, one of the biggest open air museums in Romania, documenting the countries folk heritage and civilization through time. The ASTRA includes many exhibits and historical sights including windmills, craftsman workshops, churches, and agriculture in a picturesque countryside surrounded by mountains. After the ASTRA, we went to watch the Sibiu Street Ball tournament where we had the opportunity to immerse ourselves in true Sibiu culture. We noticed many people wearing NBA jerseys and American music was being played throughout the games. We ended the night with some shopping and a delicious dinner at a Uruguay restaurant. 

Old Romanian houses at the ASTRA

Historic Windmill

Lunch at the ASTRA

ASTRA sunflower agriculture exhibit

The next day we woke up very early to catch a bus to head to Brasov, another town in Romania about two hours away. This was the most difficult day for us to communicate as we did not have our translators with us. Navigating a bus system is hard on its own, but even more so when you can’t speak the language or read the signs. Somehow, we managed to board the right bus (which was really an oversized van) and headed to Brasov. Once in Brasov, we explored many famous sights including the Black Church, Tampa Mountain, and Bran Castle. Brasov is a bigger city than Sibiu with more people, with the Bran Castle being one of the biggest tourist traps we saw during our time there. We walked through the most narrow street in Romania, Strada Sforii or the “Rope Street” and Valdora and I climbed to the top of the Brasov sign on top of the mountain (made to replicate the Hollywood sign in California). On our return back to Sibiu, we were faced with more obstacles including getting taken to the wrong bus station, avoiding being scammed by a taxi driver, and sitting at a deserted bus station waiting for our late bus. Yet we managed to make it back to Sibiu safe and sound, and enjoyed an amazing dinner at La Turn complete with an outdoor show and firework display. We were happy to be back in Sibiu which feels like home to us now.

Black Church in Brasov

Rope Street

Brasov, Romania

Bran Castle aka "Dracula's Castle"

Valdora and Ashley climbing the "B" in the Brasov sign

On Monday, it was back to work early in the morning with our translators in tow. We were going to see a teenage patient with a spinal injury who comes to the other orphanage as an outpatient as requested by the resident physiotherapist. We were told that this boy had had a deformity of his spine and surgery was performed to correct it. Due to complications, he now presents with paraplegia, unable to walk or stand. Due to lack of physical therapy intervention immediately after the injury. the patient presented with severe muscle contractures and scoliosis, however was very mobile and functional with the strength he had left. He was able to transfer himself in and out of his wheelchair, on and off the floor, and put his socks and shoes on. We addressed his functional mobility and collaborated with the physiotherapist on a home program, stretching, strengthening, balance, and positioning. The family has already traveled to Spain and France to seek alternatives for treatment. We discussed different treatment options that are used to treat patients with similar presentations back in the States. We were happy to see that this child had a strong support system at home, which was refreshing as we had yet to experience that. 

We returned back to Prichindelul to deliver a pair of braces and shoes for the baby with a history of club foot deformity. We were pleased to see that the signs we had left were still in place. We were able to say our last goodbyes to the children, who greeted us with hugs and smiles. We were saying prayers over their lives, that God would provide them comfort when they were alone and safety from illnesses. We had to keep our goodbyes short because it was so difficult knowing we were seeing the children for the last time. As we left, two of the older girls were waving us goodbye as we exited the gate. Then we had the other difficult task of saying goodbye to the rest of our translators who we formed strong bonds of friendships with in such a short amount of time. After this emotional roller coaster, we attempted to drown our sorrow with shopping, sweets, and exercise. That night we returned to one of our favorite restaurants in Sibiu, Max, where we again had another delicious Italian dinner. 

Our final day was jam packed with all of the the things we did not have time to do on our stay as well as everything we wanted to do again. Cristina, Ashley, and Sarah started our morning at a quiet cafe with delicious coffee. Our server recognized us from Prichindelul. She told us that her first visit to the orphanage was on Monday with her friend and that she planned to continue visiting. It’s amazing to witness the changes already taking place in the community for the children. She was just one example of the many Romanians we interacted with that thanked us for our visit to serve the children in the orphanage. Throughout our conversations over the past week, we have learned about the beginnings of other grass-root organizations to support children with disabilities in the orphanages.

Ashley and Cristina returned for a follow-up visit with the teenager with a spinal cord injury. It was a productive therapy session centered around collaboration between the Romanian physiotherapists and American physical therapists. Cristina and Ashley were excited that the local therapists were so open to exchanging ideas and absorbing information. The Romanian physiotherapist told them that his main focus was to make the children smile.

In the afternoon we continued to immerse ourselves in the variety of cultural offerings in Sibiu. We purchased traditional Romanian souvenirs, shopped at the local farmer’s market and walked through hidden streets and squares we had missed. Cristina also enjoyed visiting the Brukenthal Museum, the oldest operating museum in Europe. Valdora, Ashley, and Sarah enjoyed an afternoon snack at the oldest restaurant in Romania. In the evening we could think of no better place to end our time in Sibiu than returning to our favorite restaurant, Max, our favorite cafe, and then ending the night at a local pub.

Ursus Cotton Pub in Sibiu

We want to thank all of you for reading our blog documenting our time in Romania. We are eager to share more of our stories with all of you. This trip has been a blessing for all of us and we would not have been able to do it without your support. Our hope is that this trip is just the beginning of our relationship with the children and translators in Romania. Our team is grateful to have such supportive family, friends, and co-workers who assisted us in making this opportunity possible. We could not have done it without your support and prayers. We will continue posting blogs from the translators as we receive them.   

A Romanian Perspective: Ligia's Reflection

We are so grateful to our translators whom we have formed strong bounds with during our time in Romania. We asked them to write a short reflection of their experiences working with us and the children. Ligia, a medical student, has sent us the following message:

Reflection on the time spent at Princhindelul, last week:

For me, the week that passed has been a great experience. I am trully thankful to God for you guys, and for the children and the ladies that take care of them (at least some of them), for Debbie and the other translators and all the blessings that God poured over me last week. I am really happy that I had, first of all the oportunity to meet those children at Prichindelul. (I've only been there once before- at Christmas - we sang some carols, we only stayed for about 10 minutes and I had the chance to see some of the kids in the second module but I didn't get to know them). Spending this week with the children in the first module and the babies, getting to know them, has done something in my heart that makes me want to go back there. The children are soo sweet, some of them are so optimistic, happy, perseverent, ready to work hard without complaining and without giving up. We have things to learn from them. It makes me think of the words apostle Paul wrote in 1st Corinthians 1:27, 28. I didn't know much about ocupational therapy and fiziotherapy before and I am thankful that I could learn some things from you. I'm glad I had the oportunity to meet you and spend time with you this week. I think what you guys did with the children had an impact on the ladies and the director, and the children and on us. I hope the partnership with Princhindelul will continue with students from Sibiu, I hope you will come back to Romania. May God bless you in everything that you do!  

Day 6: Creating a Lasting Change

Our day was spent wrapping up at Prichindelul. We started out the morning by visiting another orphanage in town for the children moderate to severe disabilities. We met the physiotherapist on staff and he gave us a tour of the 2 of the children's homes, a hydrotherapy room, therapy gym, and sensory room. He asked us to help him with one of his patients on Monday who has a history of a spinal cord injury. We plan to return to assist him in any way that we can.

Sensory Room

Physiotherapy Gym

Once we arrived at Prichindelul, the translators completed treatment plans that Valdora and Sarah had created for the Autism Specialist, Laura. Valdora and Sarah went over the treatment plans with her for the children that she sees at the center. She was eager to implement our ideas and seemed interested in learning more about the sensory information we plan to send her when we return to the United States. We also discussed what she had learned about in the course the day prior. We shared frustrations over paperwork demands and talked about the different assessments she had been using that had been translated to Romanian from English. Laura also shared the burden of attending continuing education courses. She told us that she pays for these courses out of pocket and the next course she will be taking costs $500. This is a huge sacrifice for her and her family because her salary is about $300 per month. Laura was open to all of our ideas and it is clear she is making more connections between the children's behaviors and their sensory and medical needs.

Treatment plans translated to Romanian for Laura, the Autism Specialist

Ashley and Cristina were with the children in the third module and worked with the children during their lunch time. Ashley was able to position the four year old in a tumble form chair to assist with her self-feeding and swallowing. She was able to eat more than half of her bottle sitting up, however, she is unable to practice holding her own bottle because the center is uses glass soda bottles with nipples on top. Cristina worked with the 14 year old boy with visual impairment. She provided him with a neck roll and positioning in a stroller which allowed him to have the improved positioning and support to eat his lunch in a reasonable amount of time.

A typical bottle used for the children at the orphanage

Before lunch the entire team had a debriefing with the staff and director at Prichindelul. He expressed his gratitude for our visit and was eager to hear our recommendations. Although he was open to many of our suggestions, he explained the red tape and politics making it difficult to implement change for the children. Despite all of the barriers, he told us that they understand that as "human beings with open hearts" there is a lot that they can still provided for these children. One of our most important recommendations was to have a continued partnership with the nursing students who assisted us as translators.  The director assured us that he will develop a partnership with their university or as individuals allowing them to continue to work with the children.

Our translators, Ana, Ionna, and Ema work with Ashley to translate signs for the children's cribs

After our last lunch with the translators, we spent the afternoon completing treatment plans and signs translated into Romanian to tape on the wall above the children's cribs. Cristina and Ligia returned to say goodbye to the children in the first module. She reviewed the treatment plans they had created the day before. They also celebrated one of the children's birthday with singing and cookies Cristina had bought for them. One of the boys told the translator, Ionna, that he had a shower for the first time in the new shower seat we provided. He was so pleased to have a more comfortable and safe place to shower. He told her it was just like he was still sitting in his wheelchair. The team also received some sad news that one of the children, an 18 year old who was crib ridded had passed away. Although we were never able to meet him because he had already taken to the hospital, the team from America that preceded our trip had worked him just 2 weeks ago. We put off our official goodbyes until Monday. It was just too difficult to think we were seeing these precious children for the last time.

Ashley and Ema hanging the signs over the cribs

Cristina, Ionna, and Ligia saying goodbye to the children in the first module

The crib of the 18 year old who passed away. Romanian Orthodox light a candle for the deceased believing the light guides the soul to heaven.

We ended our day with a traditional Romanian dinner in the cellar of a beautiful restaurant. We were joined by Debbie the founder of Heart of Hope, her Romanian director, as well as our translators. It was a great time for us to thank them for their hospitality and our experiences here in Romania. This weekend we plan to sightsee around Sibiu and Basov to help us transition back to our lives at home.

Crama Siviana

Day 5: A Day for Writing and Reflection

Sarah and Valdora with Ana Maria and Gita from the 2nd Module

Today, we had a rough start... half of our team is sick and so are some of our translators. We have worked ourselves to the point of exhaustion physically, mentally, and emotionally. But, we are pushing on as we could never fathom giving up on these kids and the staff at Prichindelul. Our day started with each of us splitting up among the floors and writing down our treatment plans. These plans are important as they will be translated into Romanian and allow for the caregivers to have a clear outline on how to best serve these children thus ensuring that our efforts this past week are sustained once we are gone.

Valdora working with Jeta and Daniel from the 3rd Module

We will be giving the treatment ideas to the nursing students who will be volunteering at the center, Laura the autism specialist, as well as leaving very simple instructions on the child's crib or bed outlining their most important need that must be met. Today working with the children we saw more than ever their potential for change as they cooperated and worked together as a family. The younger children in the 2nd module were utilizing techniques that they had seen us model to help their peers.

Kids from the 2nd module helping each other jump down 

Today in the first module, Cristina also saw some tremendous progress with her kids. Sanda, a girl who has been non-verbal since our arrival, began repeating single words today. She was able to repeat the names of everyone in the room after Ligia modeled them first, saying all of the names clearly and loudly. Cristina has been teaching the children some words in sign language since it is difficult to communicate due to the language barrier and the children are loving it! Cristina is focusing on educating not only the caregiver, but also the kids themselves as some of them are old enough to play a part in their own care. Today, the children wrote down all their own treatment plans which are pictured below.

Children from the 1st Module writing their own goals including "I want to help others"

We administered some of our donated AFOs and braces to some of the children who were appropriate. They were excited to wear them and the braces were able to provide them the support they needed to be more stable when walking and standing. We were also able to provide braces to a baby with down syndrome to improve his walking mechanics and a 10 month old boy with a history of club feet to allow him strengthening opportunities and optimal positioning during walking.

Darius our "drama king" doing his hated tummy time

Sarah with Isabella and Valdora with Jeta

Based on our experiences at the center we realized that what these caregivers need is someone to explain how to provide better care to the children. We realized that they have the children's best interest in mind, we just have to help them realize what that best interest is and encourage them for their hard work in an otherwise thankless job. All of us can get discouraged with our jobs at times as we feel we are not appreciated, but we have our patients and families who provide us with positive feedback everyday. These caregivers do not have that. There are no grateful parents and the patients are not able to voice their thanks. This is why the caregivers are burnt out and why it is so tough to work in this job that is surrounded by sadness, strong emotions, and an otherwise endless battle of loneliness and frustration. We realized we needed to provide them with that positive feedback, encouraging them and letting them know that they are valued. That if the patients could speak, they would say thank you. The majority of the caregivers we have met at the center truly and deeply care for these children as their own, working for little to nothing to make their lives better.

Everyone is busy in the afternoon and working hard!

This week we have heard many stories about the healthcare system and care provided to those who are disabled or have special needs. To be born with a disability in Romania is viewed as worthless and flawed. Unlike in the United States, there are no laws or advocacy groups to fight for the rights of those who are disabled or handicapped. When a mother decides to keep and care for a special needs child, it often results in a broken family and an absent father. For example, Nicole, the four year old in the third module, was raised by her mother alone for two years. Because of her severe impairments and gross medical needs and expenses, her mother was unable to support her at home without assistance and was forced to hand her over to the orphanage. Nicole's mother continues to visit her and Nicole recognizes her when she comes. We also learned that when a child reaches the age of 18, they are forced out of the orphanage and the only place they have known as home, and sent to an adult facility. The state of this facility and the environment can only be imagined as no one is allowed to enter.

Ema working with Darius and Sarah working with Nicole

One of the reasons why it is so difficult to work with these children, is that we see so much hope and potential for their lives, yet uncertain that that potential will be nurtured and realized. We are constantly challenged to come up with realistic and meaningful suggestions that can be implemented in their current situation. As we spend time with the children, we have been trying to understand what it is like to live in their world. Things we take for granted, they may go their whole lives without ever experiencing... like fresh air, food for pleasure, social interaction with their peers, a meaningful loving relationship, or simply a purpose.  Imagine being born and living your life in the same 4 x 3 cell and looking at the same bare wall or ceiling day in and day out for your entire life. Do you think you would have the will to survive...

Day 4: A Picture Says a Thousand Words

Nicole, a four year old girl, holding Sarah's thumb

Today the emotions and lack of sleep began to take their toll, causing us to sleep in, missing workouts and breakfast. Our translators are also feeling the same way due to the busy schedule and high level of emotion throughout each day. When we arrived at the orphanage, we again split ourselves up among the floors. Sarah and Valdora went to meet with Laura, the autism specialist for the center, to observe one of her sessions and to brainstorm with her how best to help the children she sees. She has only been working with kids with autism since she started in the center in March. She has a nursing background with no other formal training in this population. But, after speaking with her and observing with her, it is clear that she has devoted her time to researching and learning how to meet the needs of these kids with autism to improve their quality of life. She was extremely receptive and eager to hear our ideas and input after having worked with the children for the past two days. Sarah and Valdora were moved to tears at the bonds that Laura had already formed with this special group of children.

Cristina started with the kids in wheelchairs from the first module whom she has been working with consistently since the beginning of the week. She was approached by the caregiver who asked her if she wanted to bring the kids outside into the garden to play. Cristina happily obliged and they all gathered outside to enjoy the beautiful Sibiu weather. All the children were transferred out of their wheelchairs to the benches or gait trainers so they could better engage with each other. All the children played games, took pictures, and sang songs. Dana, one of the older girls with CP, who had not walked prior to our arrival, and was only transferring to different surfaces from her chair, was able to climb up and slide down the slide with assistance, and walked from the outside to the inside classroom with some help from Cristina, beaming with happiness for what she had accomplished.

Mini and Cotruca blowing up balloons

 Ashley worked with her translator Ema on the third module which houses all the babies. Ashley was able to get the 14 year old boy with the visual impairment out of his crib and work on providing calming sensation, stretching, and massage to improve his alignment and decrease his pain. His usual behavior involves crying out in pain in his crib, hitting himself with his fists, and staying in one position of comfort. By the end of the session, he had tolerated 30 minutes of handling, hardly even crying out in pain. Another child Andre, with down syndrome, was also able to demonstrate the ability to stand from a small chair by pulling up, and walk with his hands held which he had not ever done before. Ashley was also able to continue teaching Ema several techniques she could use to help and that she could teach to her classmates to continue the work we are starting at the center this week.

Cotruca helps the other kids put on their braces and shoes

For a special treat, we were given the opportunity to travel to Debbie's camp that she runs for kids in Sibiu who live in the orphanage. The camp was situated in the middle of the mountains, with a running stream beside it. We were greeted by all the kids, running up to us, and trying to speak to us in English. They wanted us all to join in on their soccer or volleyball games, talk to them, or simply sit by them. We ate lunch with all the campers in the mess hall, eating a traditional Romanian meal of soup, meatballs, tomato sauce, and mashed potatoes with fresh baked bread. Ema told us that the children look forward to camp every year, and cry when they have to leave. We were so happy to have the chance to meet and play with these kids and wished we could stay all day to have fun with them. On our way back to Sibiu with the Romanian director of Heart of Hope, we had quite the tour and were able to meet some real live gypsies...

Camp with the kids!

After we returned to the orphanage in the afternoon, Cristina was led to the first module by Cotruca, one of the little girls she had been working with. She wanted to show Cristina that everyone was positioned correctly as Cristina had instructed before she left. Karina, one of the little girls with severe Cerebral Palsy, was sitting on her own for the first time without help. One of the biggest challenges facing the caregivers as we said before was transferring these bigger children into the shower. We purchased a garden chair for the shower and Cristina was able to instruct the caregiver on proper body mechanics to transfer each child into the shower chair. The caregiver was so thankful for the help and the children were able to transfer beautifully without difficulty and remain sitting independently. They finished their afternoon with a yoga session, with all the kids laughing and having so much fun.

Cristina with Mini and Dana

Valdora, Ashley, and Sarah returned to treat the babies in the third module, to continue working on oral motor and gross motor skills. While we were working with all the children in one room on the floor, the caregiver walked in and said, "This is such a happy room." All the children were interacting and playing with each other, which they most likely have never done before our arrival. The progress we have observed over the past couple days is unbelievably fast and simply amazing. We have all never seen such progression throughout our entire careers as therapists and are so blessed to have the opportunity to observe it here in Romania.

Ashley with Paula and Sarah with Isabella

We ended our night with an outstanding dinner yet again at an Italian restaurant called Max. Here in Romania, dinner is said to be a "social experience"and is meant to be savored. There is not a rush and no cell phones at the table. We have learned to embrace this philosophy and find it quite refreshing. Cheers until tomorrow. Buna Seara!

Sarah with Ana and Ema at camp

Day 3: Our road to change

Today started with an early morning workout and traditional Romanian breakfast followed by a rainy walk to the orphanage with our translators. The director of the orphanage greeted us at the door to thank us again for coming to their center and to ask us about any concerns we had after our first day. Cristina and her translator, Ligia, started in the first module. The children there were awaiting our arrival and eager to work with us. Cristina and Ligia worked with all of the children in a group room addressing many of their needs including sitting unsupported from their wheelchair, standing, and walking, as well as social groups with singing, dancing, and using Cristina's cell phone for pictures, pretend phone calls, and music.

Valdora and Sarah started their day with the second module again with our translators Ana and Ioana. Today the children were separated by age in the group rooms because of the rain. We started with the younger children and walked into a vastly different environment including a room full of toys and children ready to socially engage. We soon learned that the difference was a caregiver the children affectionately referred to as "Mama." We spent some time getting to know and asking her about any concerns or difficulties she has working with the children. Mama demonstrated her love for the children and described them as family. She takes many of the children with her to church services and told us she misses them when she is on vacation. Mama was one of the few bright lights we met at the orphanage today as she demonstrate affection and kind discipline to the children. All of the children sought her attention and her approval. Mama was open to our suggestions and eager to learn our techniques to assist her with the best care for her "family."

Ashley started working in the third module with her translator, Ema, who is in her last year of nursing school. Ema had stated that she will be continuing to visit the orphanage when we leave with her classmates and is eager to learn anything we can teach her to assist in improving the lives of these children. Ashley was able to educate Ema in developmental milestones and typical development while working with a variety of children to allow Ema to have valuable hands-on experience.  Ashley's impromptu lab provided Ema with an opportunity to learn about normal and abnormal movement patterns, varying degrees of joint mobility, high and low tone, as well as various other impairments associated with the variety of medical conditions of the children living in this module. While Ashley and Ema were working with a four year old girl with Down's syndrome, the caregiver entered the room and told them they were wasting their time. She explained that the little girl would not improve even if they worked with her for two days and that she does not try. Once again we were hit with the reality of the situation that a lack of education is one of the greatest barriers for the development and quality of life for these precious children.

Right before lunch time the entire team worked with children in the third module providing positioning and oral motor stimulation to assist with feeding. It was heartbreaking to watch children who are unable to receive proper nutrients because of their delays and impairments with self-feeding, sucking, and swallowing.

For lunch the team enjoyed a Chinese/Romanian meal complete with chopsticks. Once again the team raved over our"new" favorite dessert which changes with every meal. After lunch Debbie met us to take us to some local stores to pick up supplies. We were able to find a plastic lawn chair with shelf liners and insulated tubing to construct the Romanian version of a shower seat with straps. We also found pacifiers and other teething toys to provide the children with opportunities to develop their oral motor skills. Emma introduced us to a favorite snack from her childhood "Pufuleti" which was similar to a cheese puff made from polenta. We plan to us this snack to introduce the children to pleasure feedings and play with food.

After shopping we returned to the orphanage to finish the day. Cristina returned to the first module to check on braces she provided to a child prior to lunch. The caregiver and the entire group of children were interested in braces and the caregiver demonstrated interest and ability to apply them. Valdora and Sarah returned to the second module to work with the older children. Upon our arrival the children began asking for us to provide their preferred sensory input we started the day before. We were able to work with the children in a large group setting in a more chaotic environment. The children continued seek us out for interactions, sensory input and play. We were able to work more with the children on eye contact, reciprocal play, and social and play interactions with their peers. One of the three caregivers working with these children demonstrated successful efforts to assist with limiting self-stimulating behaviors and increased play and social skills. Three children in particular demonstrated dramatic progress including eye contact and requests for engagement. They had quickly learned that their experiences needed to be shared experiences working with us instead of just receiving the therapy we put upon them. Ashley returned to the third module to provide the children with accepting a pacifier. After extended time and positioning, some of the children demonstrated acceptance of a pacifier, increased interaction with their environment, and play in midline. We know the children in the orphanage with benefit greatly from a speech therapist. Many of them have never developed a suck, swallow, breath pattern and most have oral sensitivities making it difficult for the caregivers to feed them safely. Overall, we were amazed by the eagerness of the children to receive our care. The progress these children have made in social and physical skills in two short days is outstanding, like nothing we have ever seen in our professional careers.

We ended this difficult and rewarding day at our new favorite restaurant. We enjoyed a delicious traditional Greek meal and finished with recommended Greek and Romania desserts.

Our entire team from top left to right: Ligia, Sarah Cristina, Valdora, Ashley, Ioana, Ema, Ana, and Debbie.

Day 2: Our First Day at Prichindelul

Today was our first day treating at the orphanage. First, we met with the director of the center who welcomed us kindly and said that he was open for any suggestions we may have to improve the lives of the children. We decided our best plan of attack was to split into groups of two and hit two different modules that morning. Cristina and I began on the first module with the kids in wheelchairs, in which each child received a functional assessment to determine their level of independence. Each child was transferred out of their wheelchair and were assisted to the floor. We all joined in together and sang Romanian songs while observing each child's posture, range of motion, sitting balance, and behavior. Our translators were so helpful in giving us background information, telling us what the children wanted to do, and asked questions about how they could help them. Most of the children there were begging to walk and so happy to try. We also spoke with Maryanne, the caregiver for the children in this module, and asked her what the most difficult part of her job was. She stated that transferring the larger children into the bathtub was difficult because they are so heavy. We will be working with Maryanne in the next couple of days to give her suggestions on body mechanics and different techniques to make her job easier as well as adapt the equipment to suit the child's needs. Sarah and Valdora were paired together in the second module, which housed most of the children with sensory impairments. After seeing all of the children gather on the porch, Sarah and Valdora decided to divide the children into groups of four and treat one group at a time. The group was focused on sensory input, integration, and organization to prepare for social interaction. They quickly observed the different activities that benefitted the children's organizational skills and body awareness, and after a few minutes of sensory activities, they were able to work on "turn taking" play. The sessions ranged from jumping activities, to crawling obstacle courses, and deep pressure with each child preferring a certain type of input and some eventually began asking for more of the input they preferred. One 6 year old boy in particular exhibited the greatest change presenting initially with uncontrolled screaming, flapping of his arms, and avoidance of eye contact. After repeated proprioceptive techniques, he was able to calm down, sit at the
table, and play a back and forth game with one of the other children. It was amazing to see how quickly the right technique and devotion of time helped this child to organize and be able to play for the first time ever. For lunch we came back to the transitional home for a delicious meal of chicken, bean soup, vegetables, and a homemade Romanian dessert prepared for us. After lunch, we were able to spend some quality time getting to know our translators and learning more about the Romanian culture. Cristina was able to talk to one of the girls who was part of the Heart of Hope transitional program and was surprised to learn that she not only spoke Romanian, but also English, Spanish, and Chinese... and knew all about Columbian culture!

After lunch, all four of us decided to tackle the third and final module, filled with the crib ridden children. We were able to take each of them out, quickly assess their function and developmental needs, and determine what the easiest intervention would be that wouldn't require much work from the caregivers, but would make the greatest impact. We provided the children with opportunities to explore their environment, their own bodies, and to play with each other for most likely the first time ever. We were able to observe some of the staff feeding the children and it was almost too difficult to watch. The child with the visual impairment we mentioned in the last blog, we were told hardly ever eats and he never drinks because everything falls out of his mouth. I was able to watch him try to eat a mashed mixture of biscuits and water with spoonful after spoonful being shoveled in his mouth. He did not demonstrate any control of his mouth or tongue, and was gagging as the food entered, unable to perform a swallow. The worker stated he just sometimes doesn't want to eat. We realized after watching this, how great this lack of education actually was and how much we needed to focus in this area. We ended our day with another awesome dinner at Pardon Cafe and Bistro, just a short walk away from our hotel, and of course gelato.... yum. Buna Seara!!