Paediatric Occupational Therapy Clinic - A quick Tour

We've had the clinic open full time now for just over 18 months. Despite some things in Thailand being rather 'lax' when it comes to regulation and enforcement, running a clinic isn't one of them.

At the clinic, my wife who is a specialised paediatric occupational therapist works with children who have a wide range of issues such autism, ADHD and cerebral palsy, developmental delays and behavioural issues to name but a few. Despite there being many similar clinics around Thailand, ours is the only one here on the island and we've been running at almost full capacity since we opened. That means seven days a week and many days from 9am until 8pm, conducting in excess of fifty sessions a week. It's demanding work but extremely rewarding but requires a lot of admin and general upkeep to support the wife who works hard with her kids who are an almost 50:50 split of local and expat children.
Mostly, our kids are under ten, the youngest being two years and are referred to us by parents with concerns or from parents via schools who have raised concerns. Sometimes an evaluation and advice are all that's needed. Sometimes, there will be more long-term assistance required. In all cases, early intervention is extremely important to give a child the best chance possible of overcoming their difficulties and being able to achieve their full potential.

This was our third inspection. Our first came when we opened last year and the second was our annual inspection with only twenty-four hours' notice last November. This time around, for our second annual inspection, we had a few days to prepare and check everything was in order.

Out came the checklist...

The 'checklist' is twenty sides of A4 with many little boxes to tick. It's a general list that applies for every type of clinic with only a few small sections dedicated to the clinic's speciality, whether that be acupuncture, therapy, psychology, or general health. It really needs an overhaul. For example, we are required to have assorted medical equipment such as a stethoscope, oxygen monitors and blood pressure testers, none of which we have any training knowledge on how to use or interpret the results, even if we had a use case for them, but if we don't have them, we fail. It's that simple and the team of five that visit us make sure everything is black and white, pass or fail. There is no wiggle room or grey areas for debate. They do look and they do test they're all working, hence I must get everything out of the boxes and check and replace batteries, if necessary, beforehand.

Let's have a quick tour and see what goes on inside...

It's a small clinic but follows the legal requirements closely that state we must have a reception area, consultation area, therapy area and bathroom with adaptive devices for anyone who requires assistance. Each of the rooms has its own set of rules and regulations to comply with, even being allocated a minimum physical size.

And yes, we have toys, games and puzzles. Lots of them!

The examination bed, and the steps to climb on it, you can see in the corner is one of the ridiculous pieces of equipment we are legally required to have in the consulting room and one of the reasons the Ministry of Health needs to overhaul its requirements to create a more individualised checklist depending on the clinic's specialisiation. When we've passed, this gets put away in the store room until it's presence is officially needed again.

Fon has have a desk with lockable drawers and a chair.

All waste bins must be hands free and their purpose clearly labelled. The bin in the toilet is classed as general waste but some of the nappies that get stuck in there, I'd reclassify it as 'hazardous', talking of which, we have to have special red bags and a labelled bin for hazardous waste, despite us having none, of course! Handrails, an alarm, big tap and rubber floor mats. Check!

Cabinets in the consulting room must be lockable for storage of medical records, even though one of ours simply contains more games and toys. Despite us having to keep quite stringent records, there is no requirement or ability for us to add them onto the official national health database. Perhaps a good thing in regards to future health insurance requirements.

Thats a bosu ball . Occupational therapy is as much about the physical as the mental, especially in development delays, when its very important to improve standarised physical milestones before working too hard on motor and cognitive skills. The bosu ball is an excellent tool for building core strength which assists with issues such as integrating primitive reflexes and proprioception.

Again, steps, balance boards and mini trampolines are so much fun for the kids yet so critical to their therapy.

Balance matters!

Floor mats must be regualtion thickness as must wall padding that must extend 1.2m up the wall. Nothing to stop them bouncing off the trampoline and straight through the window though. Never thought of that, did you, Health Ministry?!

Assorted swings and rope ladders which can be interchanged with other 'swings', mini climbing wall and ball pool, good for sensory and a place for kids to chill out for a few minutes if they are feeling stressed.

If it weren't for the mess, it would be like the page from an Ikea catalogue but joking apart, they have a fantastic kids department.

Is that a play kitchen I see? Isn't that a bit old fashioned?

No is the simple answer. One major isssue with many childhood issues is known as ADL, assisted daily living, in other words, the skills a child needs to develop to be able to live independantly as an adult which no matter the severity of the case, is always the primary long term goal. Not only that, working on skills such as using a knife to cut fruit, or using scissors correctly is massively important in a child's development as they use many basic gross and fine motor skills to achieve.

Jigsaws. Oh yes, we have many of all sizes, difficulties and number of pieces. They allow us to practise many skills including improving concentration and attention skills, visual perception and fine motor skills. If these are issues for a child, jigsaws are a huge help. In the case of this jigsaw that depicts various fairy tales, describing the stories is also a big aid to cognitive and communication skills too.

And there's the boss, standing proudly outside waiting for the team to arrive. Yes, we still have to have the covid style thermometer outside and yes, we did pass the inspection without issue. Preparation is everything.

Thanks very much for reading and if anyone has any questions, please ask. Comment rewarder is on!

I hope everyone has had a great weekend and is refreshed and ready for the week ahead.

Martin
@nathen007