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Nicky Haire is a UK-based music therapist who has been focusing on a project being run by Music as Therapy International (MasTInt) in Rwanda. The charity devises and delivers innovative, high-impact music therapy projects around the world, their skill-sharing projects providing local workers with the skills, resources, experience and confidence to run therapeutic music programs with the disadvantaged children in their care.
The roots for this work lie in the orphanages of Romania, but since establishing MasTint in 1995 their work has extended to the Occupied Palestinian Territories, Rwanda, Georgia, Myanmar, Peru and back to the UK. To date the skill-sharing projects have been implemented in 78 overseas care settings, enabling 8,700 children and adults to receive regular therapeutic sessions.
Why did you choose Rwanda as the focus for your music therapy skill-sharing project?
Rwanda is a landlocked country in central Africa. With a population of around 12 million living in an area less than half the size of Scotland (around 26,338 km²), Rwanda is overcrowded, and struggles to provide enough food from the overworked soil to feed its people. Two-thirds of people live below the poverty line and healthcare is rudimentary. In 1994, around one million Rwandans were killed over a period of three months and the many genocide memorials all over the country serve to remind of this time, and of the trauma and suffering still carried by so many people.
Although Rwanda is developing economically and socially at an extremely rapid rate – with more robust infrastructure in evidence each time we visited – disability is still largely misunderstood. There is a huge amount of stigma and shame attached to having a disabled child and it is common for families to be ostracised by the community or even face abuse. With thousands of children and young adults across Rwanda either living in institutional care or accessing day centres there is an extraordinary need to equip care with skills that will allow them to address their psychological wellbeing as well as their physical needs.
The project in Rwanda was instigated by two UK music therapists, Judith Nockolds and Helen Leith who had been visiting Rwanda since 2005, working in various places with disabled children and young people. They formed links with Tubakunde, a Rwandan association made up of local organisations dedicated to furthering national awareness of the needs of disabled people. Together, they identified two centres for disabled children with a sufficiently well established staff team to benefit from MasT International’s six week skill sharing model: Ngwino Nawe and Urugwiro Centre, Nkanka.
Why choose a developing nation for assistance with an arts in health program when so much in this field still needs to be done in places like the UK and Australia?
This is a good question and one we are often asked. I guess the simple answer is that Music as Therapy International was set up in response to the Romanian crisis. In the 90’s the shocking images of Romanian orphans living in horrific conditions hit our TV screens and Alexia Quin (founder and director of MasTInt) then a 17-year-old student, felt compelled to help. She spent months working as a generic volunteer in a large institution for children with severe disabilities. This experience left her determined to do more to help change the future of children and adults languishing in the country’s institutions. However, she believed the greatest lasting impact would be made through the provision of skills and training for local people, as opposed to short-term international volunteer presence. This led to the delivery of the pilot Music as Therapy project in 1995, a second project requested by another institution in 1996 and a feasibility study across the country in 1997. On the basis of these experiences, Alexia registered Music as Therapy International as a charity in 1998 to facilitate the delivery of more projects each year.
Music is the invisible key to open the doors to an individual’s innerworld. In some of the rooms we will find pain and sorrow, in some others, joy and happiness. Only byvisiting these rooms will a child beable to find in his own way in life. As a session leader, my role is to guide that child on his journey and encourage him. Local Partner, Romania
Romania continued to be the sole beneficiary of the charity’s activities but around 2008, MasTInt started to notice a real growth in the number of British music therapists looking for guidance with their own music therapy initiatives overseas. This led MasTInt to widen its remit to help make the benefits of music therapy accessible to local staff in other parts of the world, including the occupied Palestinian territories, Georgia, Myanmar, Peru and Rwanda.
Interestingly, a little earlier, MasTInt piloted a project in the UK in partnership with the Greenwich Teaching Primary Care NHS Trust to devise ‘Interactive Music Making’ (IMM), a university credit-rated learning programme for those working with children under five. Although there is an established music therapy profession in the UK, there are still locations where there aren’t enough music therapists to reach everyone in need, or children whose needs are just below the threshold which would enable them to access clinical music therapy. Knowing the importance of early intervention to prevent the escalation of need, interactive music-making enables early years practitioners to give children a bit of extra support in meeting those early developmental milestones. MasTInt has been pleased to have had support for this area of their work from the British Association for Music Therapy, and to have been shortlisted for Advancing Healthcare Awards in both 2012 (Excellence in Learning and Development) and 2013 (Supporting the Future Workforce).
“We’ve seen some clear progress e.g. in concentration and social interaction – in at least one area always. For example, one child who had high end autistic spectrum and behavioural difficulties, this was the first time we found an intervention that really engaged him and that his parents committed to.” Nursery Manager, Greenwich
There have been a number of incidents of bad practice in our own care system in recent months, which infers there is, as you suggest, work we could be doing here too. There is currently a drive within the charity to look at how we can contribute more widely to improving the care of people living with dementia and adults with learning disabilities in the UK.
Is there something unique about Rwanda and its background of internal strife that increases the effectiveness of music therapy?
Yes, there is something which increases the effectiveness of music therapy in Rwanda. Rwandan culture is steeped in music and shared music making is recognised as a naturally expressive and communicative and way of being together. During the genocide, artists working for those implementing the killings of others used music as a devastating propaganda tool. In contrast, in church services and other community activities we experienced Rwandans’ hugely expressive singing and dancing and were amazed at the freedom of emotional expression.
This innate quality of musicianship in our Local Partners meant that they were very quick to grasp the fundamental underlying principles of music therapy and happy to improvise and experiment with different sounds in dialogue once they had tried this a number of times. So, I would suggest any increased effect is more to do with these cultural factors. In fact the charity developed an evaluation tool – a Competency Framework – which has been used for many years to ratify Local Partners’ skills. When this was implemented in 2013, Local Partners in Rwanda scored higher than anyone other MasTInt Local Partners.
What hurdles did you confront in establishing the project – e.g. funding, recruitment, resourcing, etc.
Whilst there is always a challenge with raising the required funds to deliver a project, the main hurdle we experienced in Rwanda was the threat of civil unrest. Last year MasTInt started working towards an introductory music therapy training project destined for Orphelinat Noel de Nyundo and the Ubumwe Community Centre for children and young people with disabilities in Gisenyi, North West Rwanda. Devastatingly, four days before the project was due to start, civil unrest resulted in the Foreign Office restricting all travel to the area. As a result, we had no option but to postpone the project. Thankfully, calm restored and when the restrictions were lifted we were able to resume our plans to deliver the skill-sharing project but this was not until one year later.
On the ground, during the projects and on subsequent follow up visits, we needed to be creative when sourcing and maintaining instruments for the centres. During the first follow up visit in 2011, the instruments at one centre were in good condition but at the other centre, many of the instruments were well used and worn. The rural context, lack of funds and dynamic enthusiasm of the children means that this is an on-going challenge however, Local Partners and children at both centres are always positive and imaginative in finding ways to address this, making and repairing instruments themselves and using this as part of the interactive process.
How did the local Rwandans react to your initiative?
I can honestly say the majority of our Local Partners in Rwanda have been amazing; hugely enthusiastic about learning new ways to communicate with the children they look after and interested in fully understanding them. I think many have been empowered by the training as they have been able to connect and develop meaningful relationships with the children and adults in their care.
The impact on the wider community has been noticeable. During the initial project with MasTInt in 2010, one area of focus was to bring the two centres together regularly to share ideas about using music with their children and support each other. Often, people working with children with disabilities are marginalised in society alongside the children and putting in place this peer support was invaluable. It was fantastic to watch the Local Partners grow with each other, share experiences and work together when thinking about children in their centres with similar situations.
My mind has been changed considerably because before I consider people with disabilities as the one we cannot communicate, interact…but through music therapy it is possible and beneficial not only for me but also for them. Local Partner, Rwanda 2014
During the past six week I discovered a new thing that everybody has a certain capacity for doing something. We practice inclusive education we have many people who have disability and in our society many people don’t consider them, but music as therapy is a way which will help us to work with them in order to help them.
Music as therapy is help us to know the children, the disabled children… for example the person who is unsociable, who has no place in society, the music as therapy has helped us to help that child to be well in society and to collaborate with the others Local Partner, Rwanda 2011
What have you achieved in the five years that the project has been running? How do you measure its success?
After the introductory six-week training ends, Music as Therapy International offer long-term support, working on the premise that it’s never about what MasTInt can do in the moment, but about what their Local Partners can do in the future.
It has been incredibly exciting to develop relationships with our Local Partners and learn from them over the last five years. By all accounts they continue to run the music programmes and remain engaged and eager.
Project Rwanda Steering Group: Alexia Quin, Jane Robbie, Nicky Haire and Caroline Anderson