Towards a better quality of life
Helping people to regain their mobility

Rebecca Washbourn helps people move forward, both physically and mentally. She is a physiotherapist who, when she’s not being seconded to the hospital, has spent 15 months working for Te Vaerua, the only rehabilitation service provider in the Cook Islands.
“Te Vaerua is a bunch of women who, a few years ago, saw that there were some people here who could have better functions or better abilities or better mobility or a better quality of life, but they weren’t getting some of the basic rehabilitation they would have got if they were in a bigger country,” says Washbourn. “They thought it was really important and have pushed really hard to get this service off the ground.”
Te Vaerua, in fact, came into being after the Cook Islands Community Service was disbanded in 2006, with the goal of eventually providing a community rehabilitation unit. A non-government organization, Te Vaerua receives no government funding, instead relying on donations and the kindness of strangers to carry out its mandate.
“We’ve been fortunate to be appreciated by several different groups,” says Washbourn. “The eclipse chasers were very good to us. The Sevens rugby last year did a fund-raiser for us.”
A major fund-raiser for the organization is scheduled for Sept. 4 at the Crown Beach Resort where former Telecom New Zealand CEO Theresa Gattung will be the guest speaker. For more information, contact Tina Mitchell on 21080.
While the fund-raising efforts continue, Washbourn carries on with her rehab programmes, either at a dedicated room in the hospital or by making home visits, where she often works closely with Pat Farr, a volunteer home support worker.
Turama recently accompanied Washbourn on her rounds, to experience a day in the life of a physiotherapist.
The hospital room is crowded with what looks like equipment sourced from a gym’s garage sale. In the middle of this array of metal and plastic, Liz Sosene is balancing on a wobble board.
Sosene needs extensive physiotherapy after an operation to correct a collapsed arch and ruptured ligament in her left foot.
“Rebecca has been giving me strengthening exercises to get my foot back into a mobile state,” she explains. “Most of it is working on strengthening my whole leg, my thigh and my calf muscles. Because I go to the gym, I’ve been utilizing the equipment there and also the equipment up here at the physio. Doing the wobble board and strengthening my foot that way. And also doing step exercises and lifting my toes.”
Sosene reports that her rehab is going well.
“I’m just making little goals for myself – I’ve reached the goal where I can drive my car again, and that’s good,” she says. “Just little steps at a time. My end goal is to walk properly and, if I can manage it, do a light jog. Rehab is going to be from 12 to 18 months. That is a long time (but) with help from the physio team, I’ll be able to reach my final goal. Hopefully, everything will be back to normal and my foot will be back to how it was before.”
She also has a message to those who are also currently undergoing physiotherapy in an effort to heal.
“I recommend you stick with your rehab,” she says. “It’s no good getting injured, being out for a week, and then going back onto the field or the court. You’re just going to make your injury worse. Do proper rehab with physio and listen to your doctor and your physio. And listen to your body – your body will tell you if it’s not OK.”
Most people wouldn’t think twice about walking around their own yard, but for Mama Dyer, that is a major achievement in her efforts to recover from an injury.
“I first met Mama after she’d been having physio and learning to walk again, which she still has some difficulties with,” says Farr. “What I’ve been doing is coming around seven days a week and just walking with Mama out in the garden. Our greatest triumph was when we managed to get around the mango tree and back again. We have good days and bad days: some days we walk really well and some days we don’t.”
Farr says the latest accomplishment is getting Mama in and out of her car as she works to increase her client’s mobility.
“I’m really working on getting Mama active again,” Farr says. “Getting back all the things she lost when she couldn’t move and get around.”
Farr says Te Vaerua provides an invaluable service to the island’s population despite limited funding and personnel.
“It’s amazing,” she says. “And it’s awareness, too. Since Mama and I have been going to church, a number of people have come up to us said, Oh, people in wheelchairs go out? Yes, they do go out. It’s an awareness that people shouldn’t be barred from enjoying life just because their mobility is a problem.”
Physiotherapy is all about setting goals and Farr says she’s working to restore Mama Dyer’s former impendence.
“It’s quality of life – having fun,” she says. “Mobility comes with it, but it’s having fun, seeing a smile on Mama’s face again. Mama used to cry when things went wrong, but now she smiles.”
While she would like to see Te Vaerua receive government funding, Farr says she is enjoying her role as a volunteer.
“That’s my pay: seeing things working,” she says. “I think I have the best job in the world. It is absolutely amazing. You see everyday progress. Maybe it’s a little bit, but it’s progress. It’s awesome. I just love it.”
Ake has large brown eyes that sparkle with life and a smile that could melt a glacier.
A seizure brought on by her epilepsy two years ago means Ake lags behind other three-year-olds when it comes to physical development.
“Before (the seizure), she was a vibrant little girl, which she still is, and completely normal,” explains Washbourn. “After she was sick, she had some trouble. For quite a few months, really, she was unable to do anything for herself. She couldn’t smile or talk or roll over.”
Washbourn visits Ake at her house for an hour each week. As a result of their time together, Ake can now sit up and is learning to crawl and reach for objects.
“I find it really exciting because she’s got so much better in the time I’ve been working with her,” Washbourn says. “It makes my job much easier when you can actually see the difference. There are lots of other things I’d like to do with Ake. Her talking isn’t up to her age yet. She’s not talking as well as you’d expect for a three-year-old.”
The key to working with children, Washbourn says, is to “get them to be interested enough in something to do what they will do”.
“For me, I can see that the way her back muscles work, particularly, they’re not as strong as they need to be for her to be able to walk. So I want to do lots of things that will make her back muscles stronger.”
Her goal, Washbourn says, is to eventually see Ake walk to school, “and then to be as normal as possible, to be able to do as much as the other kids can do. If we can get her walking by school time, I think that’s really realistic for her”.
Edwina is busy searching for baskets when the Turama team arrives.
The 19-year-old has cerebral palsy and is confined to a wheelchair, so the baskets are virtual and the searching is done on a screen while using a computer game called Gardenscapes.
“Edwina loves reading books but you need something more than that,” says Farr of the high-tech adventures she enjoys at Edwina’s side. “You need something that will stimulate the mind more than just reading a book.”
Farr has worked with Edwina for four months now and has seen a marked improvement in communication.
“Edwina used to talk through her mom always,” Farr notes. “If you spoke to her, she’d get her mom to answer. Whereas, now, she’ll answer directly to people, which is wonderful. She is more relaxed with talking to people now. Now Edwina asks me questions and quiz me about things.”
Washbourn explains that cerebral palsy means Edwina’s muscles “don’t work the way other people’s muscles work”.
“What we’re trying to do is to get her to be able to do as much as she can for herself. We do some stretches and, at the moment, we’re practising balancing. Sometimes we can get her to sit up all by herself.”
The goal, Washbourn says, is to strengthen the muscles that do work so Edwina can accomplish more things for herself.
“When she has the inclination, she can use a spoon and a fork,” says Washbourn.
It’s important, she says, for everyone to work towards the same goal.
“As a physio, if you see where someone can get to, whether it’s a broken ankle or whether it’s a disability, then if they’ve got the same ideas about where they can get to, then you can get there,” she says. “If they don’t think they can achieve what you think they can achieve, then there’s got to be some negotiation.”
It was just a small parrotfish but the impact of eating it has had a huge impact on Mataiti Mataiti’s life.
Mataiti suffered fish poisoning as a result of consuming the lagoon denizen. That was three years ago. Today, the former member of the New Zealand Army who was once a keen Outward Bound instructor, still struggles with his balance and speech.
“Normally, for people, fish poisoning means they just get some tummy upset and some nerve complaints like itchiness or tingling or hot and cold sensations,” says Washbourn. “Sometimes, if it’s more serious, it affects not only the sensory nerves – the ones that make you feel – but the ones that make you move. It affects how your muscles can work. It affects your strength and your coordination of movement. For Mataiti, his facial muscles have been affected.”
When the two first met, they started the rehab programme by setting the goals Mataiti wanted to achieve.
“He wanted to be able to have a job, which he’s now got,” says Washbourn “He’s working for Internal Affairs, for the Cook Islands National Disability Council. He wants to be able to walk and look after his own garden, which he is doing. He’s cutting his own grass and looking after his own planting.”
Once an active trekker who knew the island’s interior like his own features, Mataiti’s condition has improved to the point where he’s now returned to his beloved mountains.
“He’s walked across the island a few times,” Washbourn says. “He’s taken my family up into the conservation area and shown us around. He can do those things.”
Stretching and balance regimes borrowed from Tai Chi will soon be complemented by facial muscle exercises to help Mataiti learn to speak clearly again.
The key to such steady improvement, Washbourn says, is self-motivation.
“Therapy is really about taking what I know about how muscles work and giving somebody else that information so he can do all the work,” she says. “I can show him some of the steps how to get there but he needs to do the work.”
The house in Arorangi needs a good scrubbing, and there are things floating in the pool out front that you do not want to know about, but Washbourn hopes to soon call the place her second home, as Te Vaerua’s goal of opening its own clinic nears reality.
It is in this setting that Washbourn talks about her job and her aspirations.
“Mostly what people know about physiotherapy, they think of it as fixing people after they’ve had an injury,” she says. “But physio does a lot more than that. We do work with muscles or joints that are injured but we also work with people who have some problem with their movement, whether that be from a stroke or something that has happened to their muscles or their joints or their brain. We try to make them able to move again. Most of my job is about movement, getting people to move properly.”
While the ultimate goal is to fully restore that lost mobility, it can sometimes be an iffy proposition.
“Sometimes it’s possible to get back to 100 per cent,” she says. “For some people who haven’t done activity before, we can get them back to better than they used to be. But for some people who’ve had a significant stroke or a really bad accident, sometimes 100 per cent (recovery) isn’t really what you want to aim for.”
Washbourn says, as a general rule, rehabilitation and quality of life is Health-funded, an extension of what a hospital would offer, but she’s resigned to the fact that there isn’t much in the way of Government funding available in the Cook Islands, even for something as valuable as physiotherapy.
“Government has to make decisions about how they spend the money of the country and they make those on the information that they have,” she says. “I hope that, if they had more information about what we do and how important it can be for the community, that they would make different decisions, but that’s their job and not mine. It would be good to think that Health would have rehabilitation as part of its funded programmes in the next few years.”
In the meantime, like Farr, she takes comfort in the thought of a job well-done.
“I’ve had some great challenges and some things that I’m very proud to have been able to achieve with people,” Washbourn says. “I do get the sense that I’m appreciated and that does make my day much easier.”

By John Ireland

Herald Issue 463 10 June
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