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Live From Marrakech: Students Report Their Collaboration From Morocco

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students meet therapists in Morocco during pre-trip meeting

SALT LAKE CITY, preparation (Sept. 19)

Occupational Therapies graduate students in Salt Lake City and physical therapy clinicians in Marrakech, Morocco, prepare for their collaboration beginning Oct. 1 using a live video feed. The University of Utah students will advise their Moroccan colleagues on treatment options during a two-week visit, in turn the students will receive internship credit. 

 

Caitlin and Toddler

MARRAKECH, Morocco, Day 1 (Oct. 2)

Getting there is half the fun? I’m not sold. 

The beginning of our trip to Morocco has been filled with pre-boarded flight delays (2.5 hours on the tarmac plus 9.5 hours in the sky), running through airports, and missing our luggage. As of 7 p.m. on Tuesday (Morocco time), the whereabouts of our bags is still unknown. Our group completed the first day at the Moulay Ali Institute for Rehabilitation (MAIR) in Marrakesh wearing nearly the same clothes that we put on when we left Salt Lake City. It was in the mid 90’s today and unbelievably muggy, and I worked with patients while wearing my U of U Health sweater.

Despite our slightly bumpy beginning, it is exciting and exhilarating to be here. It’s hard to fully express the vibrant colors of the buildings, the cacophony of sounds, and the smells and tastes of the incredible food. The common language spoken here is Arabic, and a little French and some Spanish. The mix makes for a beautiful dialect that is nearly impossible for me to understand. Thankfully, many of the people that I’ve interacted with thus far also speak English – plus, the children that we’ve worked with speak “smiles, silly faces, and play.” True translation comes from the Moroccan therapists as it is needed.

I thought that every fieldwork I’ve been on since beginning the Occupational Therapy program at the U has been overwhelming – throw in a foreign country, jet lag, different culture and language and you’ve got yourself a doozy! All that aside, I think the main theme of what I saw at the clinic today was an incredible amount of dedication, team work, and gratitude. The mothers of the children at the clinic sat alongside the therapists in a type of “co-therapist” role as they completed range of motion, positioning, and gait training interventions. To say that the woman from the clinic are “super-moms” is an understatement.

Our goal over the next eight days at the clinic is to help develop programs to incorporate more occupational therapy interventions and to provide training to help the therapists better serve their patients. We hope to better get to know the therapists, clients, and their families so that we can help to develop programs that will truly benefit them and suit their needs.

We’re excited to tell you all more about clinic and the people that we meet along the way.

Caitlin H Winters

 - Caitlin H. Winters, OT class of 2019 

MARRAKECH, Morocco, Day 2 (Oct. 3)

Monkeys, MAIR, Macarons

We have now completed our second full day in Marrakech! While the adventures continue, we are all a little sleepier today as we got to venture to the Medina last night. This classic tourist destination is filled with vendors selling everything from spices and sweets to beautiful lanterns, pottery, and slippers. We got to walk through the tight alleyways that were lined with vendors, and even got to sample a few of the local delicacies like the olives and cactus fruits!

The walk through the alleyways led us to what the locals call “The Feeding Frenzy.” Here you could find foods that you would never imagine, goat head for example!! Most of the crew was brave enough to try some fresh bread with beef sausages (I will admit I was not among this crew ... maybe next time?!). We followed up by enjoying some amazing fresh pressed juices that were the perfect nightcap! To end the Medina adventure, we danced with the local entertainers, and even got to hold monkeys! I have to say that has been the highlight of my trip thus far. The Medina truly is an incredible place that is a MUST for those traveling to Marrakech.

We started today at the clinic. Similar to yesterday, we had the opportunity to observe some of the therapists working with the patients and get some hands-on experience as well. The common diagnoses that we’ve seen so far have been cerebral palsy, autism, hydrocephalus, and stroke in some of the adult patients. Through our interactions with the patients, we have been able to not only help with their interventions, but also to educate the MAIR clinic therapists on ideas to address varying diagnoses. This has been incredibly rewarding and the therapists have been a blast to work with! 

We are all still thinking long and hard about ideas for our programs, but there are so many areas that could be addressed that it will be hard choosing just one! Our goal is to think of areas that will be as beneficial and realistic to the MAIR clinic as possible. Today at the clinic we also had the opportunity to hear Dave present on brain injuries and spinal cord injuries. This presentation was mainly for the MAIR clinic therapists, but I know we all got a lot out of it! Dave, if you’re reading this, you’re a great lecturer!!

Other adventures today included sitting by the pool relaxing and taking a stroll around the streets near our hotel. This little outing led us to an amazing patisserie where we bought macarons that were to die for! We also learned it is best to look up the translation of French flavors to avoid licorice flavored macarons … we will call it a learning experience! We also stumbled upon some adorable stray kittens (which I attempted to being home but was promptly stopped) and some delicious fresh pressed pomegranate juice!

We are all still adapting to this crazy, amazing adventure, and we cannot wait to see what the next week and a half have in store for us!

Kenzie Smith

 - Kenzie Smith

Newspaper Roundtable

MARRAKECH, Day 3 (Oct. 4)

Newspaper! Get your newspaper!

As the clinic was roaring with life, three occupational therapists, a neuroscientist, a radio reporter, and a junior reporter sat around a table exchanging dialect in two different languages. Today a patient who has been coming to the MAIR clinic for more than a year got to live a dream, the dream of journalism.

The patient dreams of becoming a journalist, not a small task. She is currently in her fourth year of high school (what we would term a senior in the United States) and wants to pursue a journalism education. She has been coming to the MAIR clinic due to paraplegia, which has led to her being dependent on a wheelchair. Yesterday she got a brand-new wheelchair and as the occupational therapy students from the University of Utah talked with her, we learned of her dream.

With a few connections made by Dr. Sbai, owner of the MAIR clinic, we let her dream occupation come to life. I am not sure who was more nervous, Caitlin and I or the beautiful young lady doing the interview. After some coaching from a gentleman from the local Moroccan radio show and Dr. Sbai, the patient fell into her role as a journalist. She asked why we were in Morocco, what our role was in helping the MAIR clinic, and what we have enjoyed so far about Marrakech.

We also shared our advice for pursuing her dream – including “never give up, fight for what you want” and “a lot of the time it is not a physical disability that limits someone but the mental limitation they have created for themselves, overcome that and use your strengths to stand out.” Next week, Caitlin, Heidi, and I will visit the local radio show with the patient to be interviewed live.

One small step toward obtaining a young girl’s dream and one small step toward educating Morocco about the role of occupational therapy.

Lindsey Ward

 - Lindsey Ward, OT class of 2019 

MARRAKECH, Day 3 (Oct. 4)

Amazing moms and a beautiful city

What a great day! The clinic was a little slower this morning so we had time to interview the neurotherapists (a term coined by Mo Sbai that encompasses physical, occupational and speech therapies) and it was so great! We were able to talk with each of the therapists about what their life is actually like here in Morocco, particularly for a physical therapist. We learned a lot about the education process and how the Moroccan heath care system works. Mo also explained a little more about previous humanitarian efforts that have influenced MAIR, as well as Marrakech and Morocco. All of this information is so eye opening! There are so many things that we take for granted in the U.S.!

We talked about many of their patients and what they go through. Most mothers will come into the clinic with their children (the patients) on their backs. These mothers are INCREDIBLE! They are full-time caregivers, educators, transporters and EVERYTHING ELSE for these children! Which brings me to one of the coolest things we have seen here at the clinic ... the mothers are also involved in every aspect of their child’s therapy! Rather than just accompanying their child to therapy provided by the therapist, they are doing the therapy! MAIR therapists train the mothers how to be hands-on during the treatment session and they take it to heart! It’s truly amazing how much they care for their children!

We also sat down as a group with our professors and the founder of the clinic to discuss our developing program ideas. After quite a long discussion and input from everyone, our ideas finally have a skeleton of what is to come! (More on that later.) 

On the way to dinner we got to experience, firsthand, the corruption here when we were pulled over for something we didn’t do and told by the man that if we paid him 400 dirhams (about $40), he would just let us go. We figured everything out just fine but it was an interesting couple of minutes! (Ha, ha.) We dined tonight at a local outdoor restaurant that overlooks one of UNESCO’s World Heritage sites, the Jemaa el-Fnaa (Médina of Marrakech). Let me tell you, it was INCREDIBLE!! We have been immersed in the markets of Marrakech and tonight we were able to admire the beauty from afar. We are absolutely loving this city and getting to know so many wonderful people!

McCall Halvorson

 - McCall Halvorson

MARRAKECH, Day 4 (Oct. 5)

Rock the “Kasbah”

What an incredible day! 

The day started at clinic with us continuing to do treatments with the patients and other therapists. Today was also the day of our first big excursion to the capitol city of Rabat. The three-hour drive from Marrakech to Rabat was full of flat desert land and sporadic rolling hills. The dry barren landscape reminds us of home, yet we are halfway across the world. Our lunch stop was on the side of the highway at a large restaurant with a beautiful mosque adjacent to it. We were able to observe the Friday prayer as we ate our couscous, the traditional lunch served on Fridays in Morocco. Watching at least 100 men sequence through the various prayer positions was like nothing I had ever seen before. As the prayer was projected over the loudspeakers in the restaurant, the men moved in unison, softly whispering the sacred words. 

As we continued on our long drive, we sang karaoke music ranging from Journey to Garth Brooks to Broadway classics. Arriving in Rabat, you immediately feel the cool coastal air and hear the buzz of the city traffic. Our riad (house) looks like it’s straight out of a fairy tale with colored tile and intricate carvings everywhere. 

We quickly dropped our things and left the hotel to venture to the Kasbah of the Udayas. The winding alleys and narrow street-ways revealed beautiful architecture and historic homes. Our guide led us through blue painted streets to the top of the Kasbah where we were met with stunning 360-degree views of Sale and Rabat.

After finishing at the Kasbah, we returned to our riad for a delicious four-course meal. The table was filled with chicken, pastilla, and fry bread and all that could be heard were our forks hitting the plates. We went to bed with full bellies and happy hearts, ready to take on the next day.

Lexi Sybrowsky

 - Lexi Sybrowsky

 

Casablanca

CASABLANCA, Day 5 (Oct. 6)

“Praying is not about the place or what you do, it takes place in your heart.”

With a concerned tone in his voice, the first thing my dad said when I told him I was going to Morocco was, “They’re mainly Muslim in that country, right? Are you going to be safe?” Please keep in mind that my dad is the most accepting and loving man, but like many other people who I know – myself included -- due to so many recent events, many of the perceptions we have of people of the Muslim faith (unfortunately) hold some negative connotations. I’m moved to write about this subject because I feel it is impossible to be in a place like Morocco and practice occupational therapy without considering the foundational role that the Muslim religion has on everyday life. I am so grateful that within the last week, I have had the incredible opportunity to not only experience the things that are unique to Moroccan culture, but also to experience the things that we hold in common.

One of my experiences at the clinic this week united me with a man who wanted to be able to pray in the mosque again. Traumatic brain injury and incomplete spinal cord injury has resulted in significant spasticity in all four extremities, balance, gait and cognitive deficits. Growing up Methodist, my idea of prayer means sitting in a church pew, crossing my hands, listening to the person standing at the pulpit, and saying the Lord’s Prayer. Although the patient is able to pray from a chair in the mosque, he is a proud man who wants to practice his faith in the typical Muslim tradition.

In order for me to begin figuring out how to help him accomplish his goal, I first needed to understand how Muslims pray and how the patient’s deficits were keeping him from engaging in the activity. As an occupational therapist, I had to consider the position of his foot when he took off his shoe, his balance when getting into a kneeling position, his ability to remember the sequence of the verse and the movements that go along with the prayer, and how he was able to stand up and go back into a kneeling position multiple times throughout the process.

Although I considered all of the physical movements and cognitive components that he needed to master, I didn’t fully understand his setbacks until we unexpectedly had the chance to witness prayer time yesterday. We stopped for lunch at a rest stop on the highway to Rabat, and saw the men and women at the overflowing mosque at afternoon prayer. As the prayer was being broadcast over the loud speakers and after our food was delivered to the table, even our waiter ran over to the roadside mosque to join in the ceremony. Right outside the dining room window, I watched in gratitude as the men stood shoulder to shoulder and moved through the sacred movements and verse. There is no way that I could begin to understand how to re-teach this man to pray traditionally without seeing how prayers are performed and recognizing how important it is to the Muslim people. Knowing that the people complete this prayer five times a day fills me with envy of those who have such strong devotion to their faith. It is my hope that when I see the patient again next week, I will be able to give him more relevant ideas on how to engage in his practice.

In addition to witnessing prayer at the rest stop yesterday, we toured Hassan II Mosque in Casablanca this afternoon. It was a breathtaking holy place on the shores of the ocean and it filled me with even more insight on how to assist my patient. I was brave and ventured out on my own to ask the tour guide where the individuals who struggled with kneeling prayed at the mosque. His answer was quite simple - “Oh, we just bring them a chair.” But he then went on to explain that “it ultimately doesn’t matter because praying is not about the place or what you do, it takes place in your heart.”

Caitlin H Winters

 - Caitlin H. Winters, OT class of 2019 

 

People Riding Camels

ESSAOUIRA, Day 6 (Oct. 7)

Essaouira on Camels

We began our adventure today by traveling from Marrakesh to Essaouira. We had the opportunity to visit a women’s co-op where they produced argon oil. The women demonstrated the process of cracking the nuts with rocks and extracting the oil. Our next stop was to view goats in the trees!! They were standing in the argon trees where the nuts had been retrieved by the women.

Once in Essaouira we went to the pier to see all the fresh seafood for sale. A few of us got to enjoy fresh oysters and sea urchins. We then explored the streets to do a little shopping. Silver jewelry, hand woven blankets, and hand-carved wooden objects were hot items on the group’s shopping list. We enjoyed lunch at Sam’s restaurant, as seafood was a must due to us being on the coast.

We spent the rest of the afternoon enjoying the beach. There is nothing like sitting on the beach, hearing the roar of the waves, and writing a blog post about this once in a lifetime opportunity in Morocco.

Although it was a busy day which led into a long night, we look forward to going back to the clinic tomorrow to engage further with both the therapists and the patients. We plan to solidify our programs so that they encompass the needs of the MAIR clinic.

Lindsey Ward

 - Lindsey Ward, OT class of 2019 

 

MARRAKECH, Day 7 (Oct. 8)

Breaking Bread!

After a long weekend of traveling the winding country roads and the beautiful beach side of Morocco, we are back in the Red City! We started our Monday joining the therapists for their morning meeting, collaborating on the week to come. Clinic time today was focused on organizing clinic materials, interviewing the therapists and Mo on the history of the clinic, insurance structuring, and vocalizing our broad ideas for the program developments.

Three of us took a short drive to the more rural countryside, where we were able to perform home evaluations for two MAIR clinic patients. When we began our drive, we truly did not know what to expect. We knew that the homes would be drastically different than what we were accustomed to, but none of us could have imagined the experience that was ahead of us.

When we pulled off the main highway onto a dirt road, we were greeted with smiling children who directed us to our destination. When we stepped out of the car, we saw homes that were unlike anything we had seen before. Drying clothes lined the rooftops of the homes, children ran free in the streets as they played, and the adults of this community walked among homes helping each other with basic needs. In essence, there was a true sense of community, something that is not always seen in the United States.

I have to say that these were some of the most kind, happy, and generous individuals I have ever met. Their homes are, to say the least, quaint. Inside you will find a room or several rooms for larger families. These rooms are adorned with beautiful rugs and draping and house the most basic of necessities. While we observe these homes and think that they have nothing, to them it is home and it is enough to keep them safe, happy, and comfortable. We were able to observe the children in their natural environment with their loving families, as well as the school that the children attend in the same small community. From these observations, we were able to provide simple modifications to enhance the children’s independence at no cost to the families.

Our final experience in the homes was one that none of us will ever forget. The second family, as generous as the first, prepared delicious mint tea, fresh bread, and the richest golden honey and butter. Our initial thoughts were “Oh no, we couldn’t!” because they have so little.

But this is their culture. They are so generous, so kind, and so grateful for the services they receive. We sat in a beautifully adorned guest room with the two families enjoying our delicious afternoon treat, teaching the children new games, and truly feeling like we were creating a special bond with the patients. We waved goodbye to the locals and received kisses on our cheeks from the children as we left with an unforgettable, life-changing experience.

Kenzie Smith

 - Kenzie Smith

MARRAKECH, Day 8 (Oct. 9)

Day at the clinic! 

Now that we have been here over a week, we are finally starting to recognize patients ... and even better, they recognize us! I have also tried to pick up a few Arabic words this week. Just let me tell you, some of those sounds literally cannot come out of a primarily English-speaking mouth! Ha, ha! I have spent many of my sessions talking with the children and the therapists, trying to pronounce my newly learned words and it always ends in great laughter for us all! We all pretty much have our “shukraan” (thank you) down and some of us even throw in a nice “mesh esha” (little cat), which the kids love! We’re catching on slowly!  

We had the opportunity to make two more home visits today! Each of these patients lived up a narrow, concrete staircase in a small building. Most houses (including each of theirs) in this area are one main room made of concrete walls with cushions on the floor and one bedroom, which looked similar. Both also had access to a terrace with a small kitchen, which was a shared space with others in the building. It’s neat to see how the Moroccan people come together for everything. They are always trying to help one another, whether making couscous or helping you pull out of a tight parallel parking spot!

The running joke today is that for whatever we have in the U.S., there is a Moroccan version. We got to run to “Moroccan Walmart” to get stuff for lunch and supplies for the clinic. We yelled out the car window to men conversing on the street for “Moroccan GPS” and pulled over while driving through a market to buy a melon at the window of a “Moroccan drive thru”! 

Tonight we “souked” (shopped) together at the souk in Marrakech and bought some local spices. This trip has seriously been a once-in-a-lifetime experience. Everything about this culture amazes me. These are some of the most incredible people and I feel so grateful I have been able to cross paths with them!

McCall Halvorson

 - McCall Halvorson

MARRAKECH, Day 9 (Oct. 10)

Shopping off the beaten path with the locals

Today was another day at the clinic working alongside the therapists to see patients. We are seeing familiar faces and feeling excited to do treatments with the same patients while continuing to see new clients. These patients and families continue to impress and fascinate me with their dedication. They are willing to take the time and put in the work to get better.  

We were treated to a special training today put on by Katie Barker, a registered dietician at Huntsman Cancer Institute. The therapists discussed via audio conferencing some of the most pressing nutritional issues for their patients here in Morocco. Huddled around the table, the therapists asked questions and got feedback they could share with patients and their families. Katie provided specific food recommendations for patients to meet their goal, whether it was to gain weight or to lose weight. This teleconference was an amazing collaboration of professionals halfway across the world. 

After finishing at the clinic today, we headed back to the suk for one final shopping experience! As we wound through the narrow streets filled with tourists and locals, we found our way deep within the suk. This is where the tourists fade out and you can find the local people hard at work making items by hand for their shops. As I watched from afar, a man cut leather circles out of a large bulk piece. He gently wet the leather to keep it from tearing and ran the scissors through it with the ease and skill of a craftsman. He repeated the process several times, stepping away only to help a potential customer. It is small but impactful experiences like this that make you realize how important it is to step off the beaten path.   

As we mingled with the locals and sought their expertise on buying our small trinkets and goodies, the man helping us began talking to Mo and asked about the clinic. They conversed in Arabic for some time, possibly discussing what happens at the clinic and who is seen there. The man told Mo that he knew a child who could benefit from going to therapy. Without hesitation, Mo gave the man the clinic’s number and told him to call anytime to set up an evaluation. I was amazed that a simple conversation could lead to a referral, but then I realized that almost all the patients hear about the clinic by word of mouth. Seeing how a small everyday conversation can lead to a potential new client showed me how important it is to talk about the work being done at the clinic. This is what will make the clinic grow and thrive. 

We have only three more days here in Marrakech and two more days at the clinic. As our time comes to a close, I hope that we can make the most out of the next few days and leave a lasting legacy once we are gone.  

Lexi Sybrowsky

 - Lexi Sybrowsky

Marrakech Dinner

MARRAKECH, Day 10 (Oct. 11)

A farewell dinner and a changed perspective

I’m trying to wrap my head around how our trip is coming to an end so soon. Thinking back to last week and how shocking everything was – the traffic, the language, the food, not being able to read street signs – it seems funny now that we’ve gotten settled into our little bubble here in Marrakech. After just two weeks, things have begun to normalize. Cars that are three wide in a single lane with scooters in between no longer make my eyes bulge, and I catch myself walking around with my mouth open in awe only a couple times a day instead of constantly. I’m most impressed by my confidence in crossing four lanes of traffic that never stops and has a chaotically organized rhythm.

After getting to know the clinic, therapists and clients, one of the hardest things when I think of leaving is that I see so much that we can do to help them get closer to their goal of expanding their neuro training and opening a more established rehabilitation program. We have done a lot of collaborative, on-the-spot education but there is still so much that can be done. My hope is the clinic continues to thrive so it can keep providing services that make such an incredible impact on so many people’s lives.

As a farewell celebration we went to dinner this evening at a spectacular place called Dar Moha in the old medina. We were served the most authentic and delicious Moroccan fare, which was an excellent way to cap off our time here. We sat and laughed with Dr. Sbai and the therapists as we recalled all kinds of great happenings from our time at MAIR and in Morocco. This trip provided an incredible perspective of what OT can look like across the globe – a perspective that has changed my life forever.

Caitlin H Winters

 - Caitlin H. Winters, OT class of 2019 

Marrakech Orphanage

MARRAKECH, Day 11 (Oct. 12)

Orphanage, Support Group and Lamb Head! Oh my!

As the last morning of fieldwork has arrived, a variety of emotions are upon the student therapists. Some students are excited to go home to sleep in their own bed, visit with their husband or see their pet. Even though there is a lot to look forward to when going home, we are devastated to be leaving the clinic. Such a positive environment exists within the clinic between the therapists and the patients, as well as the parents. Working with the mothers and these children has been such an incredible opportunity.

Just like any other morning, we spent our time co-treating with the physical therapists and collaborating as a team to provide therapy recommendations from an occupational therapy perspective. During lunch we visited the local orphanage, a facility where a few clients live. The orphanage had a very positive atmosphere and all of the children were adorable as they ate couscous. The staff gave us a tour and showed us all of the toys and variety of equipment they use to engage the children in play, as well as completing their home exercise program as recommended by the physical therapists at the MAIR clinic.

This afternoon we spent our time in a support group with the mothers of children receiving services at the clinic. The energy within the group was beyond description. We could feel the energy in the way they spoke and engaged with one another even though we could not understand what they were saying.

After the clinic closed, a few of the students and Mo went to the souk for last-minute shopping and the opportunity to try lamb head and cow head. Surprising, it was not as bad as I had anticipated, although it is still hard to eat as other cooked lamb heads are staring at you as you gaze at the display. We then made a trip to No. 48 juice shop for our last Moroccan juice experience! On the way to the car we ended up stopping for more treats and eating wonderful ice cream!

Overall, this trip has been incredible. Not only did we learn about Morocco and its culture, but we also learned about the abilities and specialties of the therapists here at MAIR clinic. We have all discovered a way to implement aspects of occupational therapy into their clinic in order to enhance services and promote greater outcomes.

Lindsey Ward

 - Lindsey Ward, OT class of 2019