By Cleo Fleming

For the estimated 1.7 million Pacific islanders living with a disability, services on the ground are thin. The work of Kylie Mines and Motivation Australia is improving access to rehabilitation and assistive devices for an often-neglected population in an often-neglected region.

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People and their stories

A picturesque cottage in the beachside suburb of Aldinga on South Australia’s Fleurieu Peninsula serves as the headquarters for Motivation Australia (MA), a development organisation collaborating with local partners in the Pacific to provide health, rehabilitation and assistive technology services.

The cottage is filled with stories, they decorate the walls in the form of photos of the work Motivation Australia does and the people they work with, and they fill the air when program staff update the rest of the team on their work with partners throughout the Pacific.

Field work puts MA personnel in touch with people across the spectrum of mobility service use and provision. As such, the stories they tell might be about the people who access the Community Based Rehabilitation Unit that MA and the Solomon Islands Ministry of Health and Medical Services are jointly supporting. Or about visiting their partners in the Tongan Ministry of Health to map out the next steps in the new rehabilitation facility they are building together. Or they might be sharing news of their meeting with members of the WHO Global Cooperation on Assistive Technology team to progress the planning of a joint open access training resource to build local skills in providing assistive technology products.

They may also be stories of the people they didn’t plan to meet but with whom they had a conversation or shared an experience that has planted a seed, which is now germinating into something bigger. After spending a little time with Motivation Australia, one comes to understand that people and their stories are at the heart of how they work, and that the organisation itself has a truly motivating story of its own to tell.

From a home office in Adelaide

Motivation Australia was started in 2007 by now CEO Kylie Mines as a project-by-project consultancy run from her home office in Port Wilunga, a semi-rural suburb of Adelaide. A qualified occupational therapist (OT), Kylie’s career in international development is a study in perseverance and a testament to her passion for ensuring that everyone is able to participate fully in life.

After gaining her OT qualification in Australia and some experience working with children with disabilities, at 22 years old Kylie applied to work in Romania. Like people across the western world, she had been shocked by the conditions under which Romanian orphans were shown to be living during the dictatorship of Nicolae Ceausescu, which collapsed in 1989. She was unsuccessful in her application but learned from an Australian-Lithuanian friend and speech therapist that conditions were similar in Lithuania. They teamed up and raised the money to travel to Lithuania with toys, equipment and funds to work in rehabilitation centres, a newly-formed special school and with parents’ groups.

Neither the fundraising nor the conditions would have been easy, but this experience laid the foundation for her next significant development role, as the first clinical staff member to be recruited by Motivation UK (now the Motivation Charitable Trust). Kylie was hired in 1993 to establish a national wheelchair service network in Cambodia. This project was the beginning of seven years of program work with the organisation in Asia and Europe, during which she met her husband Ray Mines, now Motivation Australia’s Director of Design and Innovation.

Ray is an industrial designer who joined Motivation UK as a “wet behind the ears” graduate looking for a challenge. Over the next four years he discovered his aptitude for and commitment to designing assistive technology that both fits the person using it and is suitable for the environment in which they live.

In 2000, with plans to begin a family, Kylie and Ray moved to Kylie’s hometown of Adelaide. The move to Australia was also an opportunity for them to begin learning more about and focussing on mobility services in the Pacific, as Kylie had begun managing a Motivation UK project in Papua New Guinea to establish a new wheel chair service.

From here, Kylie began, “conversation by conversation” in both Australia and the Pacific, including for many years in Timor Leste, to build the relationships and nurture the understanding about mobility that would eventually allow her to launch Motivation Australia. (While there is a connection in name to the Motivation Charitable Trust, they are independent of this organisation, though David Constantine, Co-Founder and President of Motivation UK, is a member of the MA board.)

In a recent interview with the ABC, Kylie recalled her disappointment during her first visits to Pacific island countries of finding “piles and piles of junk” in the form of unsuitable wheelchairs. With the very best of intentions but no understanding of the need for the assessment and fitting of mobility devices, charities were donating wheelchairs that simply could not be used by the services and individuals receiving them. As with other assistive technology products, like glasses or hearing aids, a generic wheelchair will do more damage than good if used on a regular basis.

Initially Kylie and Ray anticipated that their work would have an Asia Pacific reach. However, the more they engaged with the Pacific, the more they came to understand the neglect of the region and the need to focus there. Today, Motivation Australia MA is the only one of the 120 members of the peak organisation for Australian international development NGOs, the Australian Council for International Development (ACFID), to have a Pacific-wide focus.

People: the key to success

In just over ten years, MA has expanded from Kylie in her home office, joined a few years later by Ray, into a 12-person team comprised of five support staff and seven program staff. Though still a relatively small organisation, they have developed their mission and grown their funding year on year.

MA’s annual budget is now over one million dollars. Funding comes not only from the Australian community and the Australian aid program through its NGO support program, but also from international organisations and, importantly, partner governments.

From their initial projects in Papua New Guinea and Timor Leste, MA now also works in Fiji, Kiribati, Samoa, Solomon Islands, Tonga, Vanuatu and the Federated States of Micronesia. And while strong local partnerships continue to be the primary focus of their work, the organisation has an increasingly significant voice within the regional and global dialogue on disability and inclusion thanks to their active collaboration with national governments and influential bodies, such as the World Health Organisation and the Pacific Disability Forum.

It comes as no surprise to learn that Motivation Australia’s staff are key to its success. Because they are a small team, Kylie has been very conscious of “who’s got what skill set because everything gets used”. So, with each new staff member, MA has acquired not one set of skills but a range of them.

Service Delivery Manager Lauren Flaherty is a case in point. Lauren is an occupational therapist with experience in wheelchairs, seating and physical rehabilitation. She was the first formal recruit to the organisation, joining in 2010 to work on projects such as Wheelchairs for Kids in Solomon Islands, which saw her assessing the suitability of Motivation Australia-designed wheelchairs for children with cerebral palsy.

Fast forward to 2018, and Lauren divides her time between training and mentoring clinical and technical staff in the Pacific in the provision of assistive technology services; working with local partners to develop systems and procedures for mobility device services; collecting and analysing data on service provision; and leading MA’s social media and web presence.

Kylie’s ethos regarding staff capacity in Australia is mirrored in MA’s work with local partners. More and better-quality training and service resources for local service personnel and managers is a key organisational goal. In the past year, this has translated into 205 Pacific Island personnel being trained by MA in wheelchair service delivery, diabetic foot wound care and service systems, and five people being supported to study prosthetics and orthotics at internationally-recognised training centres in India and Cambodia. This kind of training is vital to the expansion of access to rehabilitation and assistive technology services in the Pacific, and it also generates some of the best stories that Motivation Australia and its partners have to tell.

One such story belongs to Tebakaro Aata from Tungaru Rehabilitation Services (TRS) in Kiribati. A prosthetic, orthotic and wheelchair technician, in 2006 Tebakaro undertook a one-year certificate programme in prosthetics and orthotics at the Cambodian School of Prosthetics and Orthotics. With this qualification, mentoring and further training from MA he was ready to step into a training role himself, the first being an eight-day wheel chair service course in Vanuatu that he helped to deliver in 2018.

Like an increasing number of the people that work in the mobility and rehabilitation services that MA has helped to establish or expand, Tebakaro has experienced amputation and prosthetics himself. After a motorbike accident in 2001, he needed to have his leg amputated. Like many of the people he now assists through TRS, it took years before he received a prosthetic leg.

In a blog post for Motivation Australia, Tebakaro says that sharing this personal experience gives his clients hope for their future and helps to encourage them to see the benefits of mobility devices and exercise in their recovery. In recognising this he alludes to one of the major challenges for Motivation Australia and its partners throughout the Pacific.

Telling a different story

 While the World Health Organisation estimates that approximately one billion people around the world (or 15% of the global population) live with a disability, the international understanding of and response to disability is fairly limited.

A major step forward was taken in 2006 with the adoption by the United Nations of the Convention on the Rights of Persons with Disabilities. The treaty was designed to change the way that people with disabilities are viewed and to ensure that they are given access to the same rights and opportunities as everyone else. It has since been ratified by 15 Pacific island countries and signed by Solomon Islands and Tonga.

Although attitudes are shifting, the Pacific Disability Forum finds that Pacific Islanders living with disabilities continue to face “entrenched cultural and physical barriers to full participation, as well as exclusion from communities, education and the workplace.” To place this in a larger context, the Australian Human Rights Commission tells us that in Australia “negative attitudes, physical barriers and difficulties accessing necessary supports still limit the opportunities of people with disabilities to find work, study, socialise and be included in community life.”

Negative attitudes and physical barriers are clearly the largest challenge to more people accessing the kinds of rehabilitation and assistive technology services that MA and its partners provide. However, in her foreword to the Development Bulletin’s 2009 issue on disability, disadvantage and development in the Pacific and Asia, Pamela Thomas noted that “often the problem is one of information, understanding, and of being aware that something can be done and there are services available.”

This has certainly been the experience of Motivation Australia and its partners. Getting information about services out to people in rural and remote areas, correcting misconceptions about what attending a service will involve, and educating people about when to attend a service are ongoing priorities for their training and capacity building projects.

With this as the backdrop to their work, MA has set its sights on telling a different story about disability, one in which it is not treated by governments or international donors as a stand-alone activity. Kylie explains that the starting point for this is a recognition that at some point in their life everyone will require the services associated with rehabilitation, assistive technology or a mobility device or aid. And she’s right, think about physiotherapy, glasses, hearing aids, crutches and canes.

Reframing the issue means not only helping to build the capacity of their partners to deliver a greater number of disability-specific services but to make mainstream services more inclusive and accessible. The Tonga Rehabilitation and Mobility (TRaM) project that MA commenced in February 2018 in partnership with the Tongan Ministry of Health, with funding from the Australian Government’s Disability Inclusive Development programme, is a good example of what this looks like in practice.

The project involves renovating and equipping the existing Physiotherapy Department at Vaiola Hospital, the main hospital in Tonga, and training personnel in order to expand the range of services offered. New services will include a mobility device service and diabetic foot care, which will be pivotal in winding back the increasing numbers of avoidable foot amputations that the hospital sees due to complications from diabetes. The new services will assist a cross-section of the community, including people with disabilities, non-communicable diseases and the frail aged.

Change in motion

Back in the cottage on the peninsula, there’s a definite buzz in the air about the TRaM project, for which tools, equipment and mobility devices are now being purchased. Much of the energy and enthusiasm comes from Krystal Panakera Thorpe, MA’s Fundraising Coordinator.

In an increasingly competitive funding environment, Krystal is acutely aware of the importance of being able to tell Motivation Australia’s story in a way that Australian donors and the wider community can relate to. She’s decided to focus on how assistive products and rehabilitation services change people’s lives. She is also emphasising the strength of the local partnerships that MA has developed over the past decade and the expertise that they have generated in assistive technology provision.

Krystal’s ability to tell these stories is being aided by the data collection and analysis that MA is working with its partners to undertake and strengthen. More accurate reporting on the reach and impact of services is important to both MA’s fundraising efforts in Australia and to the advocacy work of their partners in the Pacific.

Analysis such as that provided by MA’s Katrina McGrath in 2016 showing improved clinical outcomes and greater cost-effectiveness from the introduction of a multi-disciplinary diabetic footcare clinic in Samoa, provides an essential evidence base to compliment the individual narratives of change that Krystal is endeavouring to share with a broader Australian audience.

But perhaps the most compelling story to share is that of Kylie Mines herself: her decades of service, and her success in building Motivation Australia into an effective supporter of local organisations in the Pacific working for mobility for all.