Paul Panda Farnana Prize

The partnership between the University of Antwerp and Fanarenana Rehabilitation centre in Antananarivo (Madagascar), promotes collaborative thinking and knowledge exchange in order to create meaningful change for handicapped Malagasy children in the face of stigma, poverty, ignorance and human health issues. While there is increasing recognition for the value of such partnerships, demographics; cultural and contextual differences and lack of financial funding make them difficult to sustain. Hence the desire to mention the above partnership. 

It all started in 2015 when the now founding members of non-profit organisation: Joella’s smile (based in Belgium), visited Madagascar and Fanarenana, and met Roselyne Ravelojoana and her family. At that time, the family was taking care of a 6-year old girl, Joella, who needed an operation for a clubfoot. Her parents couldn't afford it so Edith’s family raised the money for the intervention and the Fanarenana team continued Joella’s revalidation. It was then and there that the NGO, Joella’s Smile, was founded - to support Fanarenana and its young patients as much as possible. Joella is one of many children who have benefited and still benefit from Fanarenana’s services over the years. Fanarenana, which means ”recovery”, is a rehabilitation centre for disadvantaged, disabled children and their caregivers. In addition to providing them with physiotherapy, ergotherapy, recreational sports and basic education, Fanarenana also focuses on the exchange of experience and therapy training for parents, organising workshops and visits to schools and other rehabilitation centres. 

Every year since 2017, with the support of Joella’s Smile and in cooperation with the Faculty of Medicine and Health Sciences at the University of Antwerp, Fanarenana provides internships to motivated first Master Rehabilitation Sciences and Physiotherapy students. They travel to Madagascar with the goal of exchanging knowledge and skills at Fanarenana and gaining invaluable expertise and insight in their field. Meanwhile, at the University of Antwerp’s faculty of Design Sciences - more specifically its study programme: Product Development - Pieter Tieleman (driving force of Joella’s smile and retired teaching assistant at Product Development) and Prof. Kristof Vaes have been promoting master theses concerning the research and development of orthopaedic devices for disadvantaged handicapped children in Madagascar, starting with Fanarenana’s patients with whom a lot of the prototype testing is carried out. Significant focus is paid on involving local expertise and local, commonly available materials (preferably ecological and reusable/recyclable) for solutions optimally suited to the context. Within the scope of these theses, a production plan for the manufacture of the orthopaedic devices has been made available to local craftsmen, and future steps include the set-up of an atelier for production purposes.

The partnership between Joella’s smile, the university of Antwerp and Fanarenana has held strong for almost ten years to provide handicapped Malagasy children with the consistent care they need to gain an improved quality of life, while giving Belgian students and Fanarenana’s physiotherapists the opportunity to grow not only in their chosen field of study/work, but as global citizens whose perspectives are broadened to include other beneficial ways of thinking. The therapy treatment and developed orthopaedic devices resulting from this hands-on collaboration contribute greatly in the fight against a better world. For maximum impact and accessibility, it's important that the provided care is suited to the specific context. This is something that the partnership has been focussing on by prioritizing equal dialogue and critical reflection, as well as promoting design that combines expertise and employs local, sustainable techniques and resources. The latest completed master thesis (Tsikelikely, Laura Hauspie, 2023-2024) at the University of Antwerp's Product Development, focused on the design and development of a low-cost, standard dynamic night ankle foot orthosis (AFO) and accompanying rehabilitative support service fine-tuneable to the specific needs of children in Madagascar suffering muscular contractions and shortening as a result of Spastic Cerebral Palsy. The provision of the designed service delivery includes the evaluation and measuring of the young CP patients, the manufacturing of the AFO, fitting, optimalisation and delivery of the finished product, as well as follow-up, repair and maintenance. The sourcing of local, commonly available craftsmanship and materials (mostly natural, reused or recyclable) facilitates cost-effective, eco-friendly production and maintenance, while providing employment and support to local communities - hereby contributing to the economic growth of the country. Training people with mild forms of cerebral palsy to manufacture the night AFOs gives them a sense of purpose and competence, and promotes stronger cohesion within the CP community. It gives disabled people a chance to participate in society. Templates and mould catalogues have been made to facilitate the production of the AFOs, while the recuperation of discarded MDF moulds from Belgium in the production process further contributes towards a sustainable, eco-friendly product-service. The Tsikelikely night AFO can be used by the same child for two years before being passed on to a second child. It is well-fitting and adjustable for maximum patient inclusion and so that comfort and medical effect are not compromised. Wearing the device every night helps to maintain and improve ankle range of motion and reduce spasticity so that the child can gain more comfort and independent mobility. It can be implemented from the age of 2 for maximum preventative impact. Earlier treatment also improves wear tolerance while stigma and societal exclusion are reduced.