The Board Discovers the Adaptability of Cardboard

After working closely with Physical Therapist Andrew Suseno to provide workshops on adaptive design and basic rehabilitation in Tipitapa, our Board of Directors was eager to learn more about how cardboard, a ubiquitous material worldwide that is very strong and highly versatile, could be used to improve lives. So when we were all invited to visit New York-based organization Adaptive Design, which engages children and families in adaptive design solutions that enhance the developmental, social and academic potential of children with disabilities, we were very excited, and also very curious…

Adaptive Design runs their office and workshop from the heart of Manhattan, and as you look around you start to realize how many things are made of… cardboard! The seats we were all sitting on, in a variety of customized designs, footrests and a storage unit/office desk which covered an entire wall. Before letting us loose in the workshop, Executive Director and Founder Alex Truesdell explained how important and relevant the organization is throughout society – it investigates ways to integrate people with disabilities, it is not only environmentally friendly but also environmentally sustainable, and it offers grassroots solutions for tackling all these issues, bringing together therapists, teachers, parents, students and children. Two short videos, Among the Giants and A World of Difference with Cardboard provide an inspiring introduction to their work, and leave you wanting to know more about how you could help.

Alex began the workshop by building a simple box – at least, she made it look simple! But once we had learned the basic skills through narrating her actions as she glued, cut, perforated and bended the cardboard, we were on our way to creating our own “adaptive designs”. By not using verbal cues when teaching us how to build, Alex had demonstrated that sharing the skills of working with cardboard was not dependent on speech, and linguistic barriers can be broken down. This is especially relevant to our work in Tipitapa.

The finished productsWithin the hour, most of us had made a box out of cardboard, the only rule being that the box could not be four sided. The chairs, stools, tables and cardboard educational tools around us started to make sense as we learned how to seal any gaps, make curved edges, and increase the strength. A coat of Primer and then paint further secure the cardboard structures from deteriorating over time or water damage, creating a durable, colorful, fun piece of equipment. We will be showing some of these at our Fall Fiesta – please do come and take a look!

With huge thanks to Alex Truesdell, Kathy Goldman, Andrew Suseno and the team at Adaptive Design for this fantastic opportunity. For more information please visit the Adaptive Design website:

Tipitapa Communities Continue the Great Work of Andrew Suseno

Testing arm flexibility and muscle strength in the final workshop By Andrew Suseno

In our final advanced round of workshops Rosa, Gretchen and I were honored to be joined by Alejandro Aldana Solares, a physiotherapist from Guatemala who traveled to Tipitapa especially to share his training with local communities. Alejandro quickly integrated into the curriculum and took on a leadership role which would guide the community rehabilitation teams beyond this weekend.

Thanks to a successful meeting with the director of the Tipitapa hospital and a very supportive Director from the Ministry of Health, we were able to schedule a fourth workshop in Tipitapa while I was still in Nicaragua. The Director commented that my method of teaching was unique and that she wanted her educators to learn how to palpate, stretch and exercise muscles, evaluate children and learn my pedagogy. They would be joining us in our final “talleres”.

The workshop in the center of Tipitapa went very smoothly. Challenges were presented on how to turn a box which could be stood upon into a balance board or balance chair, and participants were tested on the joints of the body to figure out how best to help a child with cerebral palsy to stand up. Five participants in this workshop also attended the Advanced Workshop as per the request of the Director of the Ministry of Health, along with 20 others from Ciudadela and San Benito. Here we focused on reviewing rehabilitation skills, working in rehab teams and the construction of four pieces of adaptive equipment for children in their communities. By the end of the day, I could feel that the educators were hungry for more and participants were super charged, ready to continue developing their skills, and ready to work in teams to make a difference in the communities.

I am so grateful and appreciative to the donors, the Dos Pueblos staff, Alejandro, and the open hearts of all 70+ family members and educators who attended these workshops. I drew such joy from feeling their sense of accomplishment and empowerment, and their new understanding in being able to evaluate and treat another person through the construction of beautiful, functional and specific adaptive equipment. I am looking forward to supporting and building this project. Since we were able to raise above our minimum target, we have resources to support Alejandro in teaching more “talleres” in the months to come. We also discovered several leaders in the community ready to stand up for the underserved or unseen, and ready to make well-being and quality of life for all in the community something to fight for.

Jermania from Tipitapa Shares her Thoughts on the Adaptive Design Workshops

In the Basic Rehabilitation and Adaptive Design workshops recently held in Tipitapa, Board Member Gretchen Craig spoke to Jermania from Ciudad de Dios. Jermania’s community recently worked together to dig trenches for pipes, and now they have been attending workshops with Physical Therapist Andrew Suseno to see how they can improve the lives of children with disabilities. These workshops will provide caregivers with the necessary skills to construct rehabilitative equipment out of cardboard, and to integrate all members of the community, regardless of their disability.

By Gretchen Craig

Q: How will you use the information you learned in the workshops with your family or community? A: I can use what I learned in many ways. As a community leader, I hope to share the workshops with other leaders, educators, and parents so they too can learn what I did. I can show them the tools they need to work with disabled children and sensitize leaders to offer more support to disabled people in our community, teaching them that many children can recuperate – maybe not completely, but by a great amount with the right therapy. As an educator, I can also share these skills so that the needs of disabled students at school are better understood. I would like to form a cooperative to make adaptive equipment for parents who can´t afford to buy it elsewhere.

Q: What was the best part of this workshop? A: For me the best part of the workshop was constructing the adaptive equipment out of cardboard. I didn’t think we would be able to complete several large pieces in just two days. Once it was painted it looked just like wood. I also liked learning more about physical therapy exercises and massage.

Q: Would you like to learn more about physical therapy and/or the construction of adaptive equipment using cardboard? A: Primarily I would like to learn more about the physical therapy exercises, because they are what people need most. I think that the basic movements are the most essential thing for disabled children.

Q: What did you think of how the workshops were conducted? A: The methodology used was excellent. The workshops were creative, participatory, and very hands-on. Now I understand that with more support, disabled children really can do more. Overall, I loved how easy it was to learn because it made us think and we could be creative. When working in a team it’s great to imagine, create, and find solutions.

Q: Is there anything else you would like to share? A: Well, one thing is that for many the boxes are hard to obtain and people can’t afford to go into Tipitapa or Managua to pick them up. It would be great if we could have a central place near our communities, such as the school where the workshops were held, where we could get boxes and borrow tools to make adaptive equipment.

See what Jermania thought of the workshops in this short video: Tiptapa interview

Adaptive Equipment Makes a Difference

The first workshop in Tipitapa: Andrew shows parents and children how to use cardboard as a means of physical therapy By Andrew Suseno

“1, 2, 3, Freeze. Please stop measuring, cutting, and gluing!” The eyes of four closely huddled groups willfully peeled their attention away from their projects to look my direction. They were engrossed in their last cardboard construction challenge of the intro workshop: to make a cardboard box strong enough to stand on. “Okay," I said, "I want you to take one minute to reflect about the past 15 minutes with your group. Together, name one good theme and one bad theme that arose in your experience of working together as a team. And think of something to do differently to address the bad theme.”

The approach to this taller - or workshop - differed greatly from the first. Rosa and I realized that this was the first time that all seven of the different communities would be together. Many participants did not have much experience working creatively in groups – and some were perhaps too used to being the outspoken leader of a group! I also learned from my first taller that touching each other with attention was so new to some of the students that we would have to do much of it to overcome the initial shock, in order to begin engaging in learning about the body.

And so when the director of the Ministry of Health came to observe what we were doing that day, she arrived to see five different groups clustered together attempting to figure out how to find the exact beginning and end of the bicep muscle. When a group was ready, I randomly chose two members and brought them outside to demonstrate how to find the muscle on my arm. If they were unable to locate it or say how they found it, I gave them a tutorial and sent them back to the group to share their training with the others. (I'll share more about the director in the next blog.)

As this taller drew to a close, I could feel a wonderful sense of accomplishment among the students. All the groups had successfully worked together to construct boxes that I - at just under 150 pounds - could stand on. People who had not spoken before now jumped in with ideas and ways to evaluate and treat the final case studies I role-played with them, and those who had previously led listened and welcomed the teamwork. It seemed to me that we had achieved a level of understanding about what a muscle was and that they could help alleviate pain in it, stretch it, strengthen it and make a difference in a community member’s life.

Reflections from Andrew's First Rehabilitation and Cardboard Construction Workshop

Cardboard Construction Chair Design By Andrew Suseno

It’s hard to put into words how it feels to hear that most of the adults who attended the first workshop on rehabilitation and cardboard construction are already talking about coming back for the advanced session. Around 15 adults took part both days, and I can surely say that the “taller” was a great success.

My initial intention was to teach participants how to take a simple history, assess passive range of motion and strength, and to build a small box, followed by balance assessment, assistance requirements and making the necessary equipment from our cardboard supplies on the second day. But we had to adapt some training along the way – we discovered that some participants could not read or write, while others were writing down every word I said. As we determined the character of the class, I realized that we should focus on the skills learned in day one in more detail, and save day two for the advanced session. This meant we were able to devote time to assessing passive range of motion and strength testing at different joints.

The cardboard experience was interesting, to say the least! We had asked everyone to bring in 15-20 pieces of cardboard, but most people turned up with two. Fortunately the first day we were only making single-layered small boxes, and so in preparation for the second day we went to the super market and picked up a trunk full of cardboard. When we started on day two I asked everyone to glue pieces together to form multiple-layer pieces which we would use for our actual equipment (kind of like a cardboard version of plywood). Some planks were three layers and others were 6-9 layers, and in the end we had six planks for just over two teams to each make an inclined seat insert that would change the angle of a seat for a child with hypotonia.

I am very excited to try a new approach for learning with the second introductory class. My goal is to have them walk away with simple but applicable concepts, and more importantly to foster a class where participants can develop confidence with touching each other and thinking about the movement of the muscles and joints of their bodies and others, regardless of their ability to talk or write about it.

I want to give a special thanks Jonathan for translating for me when things got a bit hairy, and Gretchen, Karen, and Rosa for working alongside me with the individual groups.

Dr. Andrew Suseno Teaches Rehabilitation and Cardboard Construction in Tipitapa

After helping children with mobility issues in an orphanage in Managua in 2011, Physical Therapist Andrew Suseno was eager to  continue sharing his skills in rehabilitation and cardboard construction in Nicaragua. After meeting with Dos Pueblos to organize workshops which would train caregivers in adaptive solutions for living with a disability, Andrew is now in Tipitapa. The warmth of those in the communities is more than he could have imagined as he sees months of careful planning come to fruition. Helping the community use cardboard to make a difference

Andrew Suseno:  I finally landed in Managua at 1:30 early Friday morning, and was greeted by Rosa, Dos Pueblos' lead coordinator, and Gretchen, a New Yorker who is fast becoming 'nicaragüense', holding a sign that said "Dr. Andrew".  The sound of confused roosters and the tiny 'zancudos' (mosquitos) did nothing to stop me falling into a deep sleep, ready for the week ahead.

On the first day we headed to the Tipitapa hospital to meet the director. His office felt like the refreshingly cold air of the subway after being outside in the New York heat. He was excited about introducing cardboard construction to the families of Tipitapa, where there was currently no solution to address the adaptive equipment needs of children.

In the afternoon we attended a community meeting, sitting in white plastic chairs with men, women and children on the porch of a concrete clinic. Family members crowded around with interest and concern, mothers held toddlers on their laps, and men sat on the paint-chipped floor. At first I was nervous about how to connect with everyone, but once we started talking they told me about a child with a learning disability, another who is unable to use her entire body except her head, a man who has not been able move his left arm since he was a child, and another young girl who was blind and could not stand. How could we reach a place of problem solving together with such vastly different needs? Then, somehow, between my middling Spanish, the questions I had prepared (What were the prior successes of the community? Tell me about an issue your child experiences in the school system?) and the excitement of cardboard construction and rehab, we began to see that we could engage the community in questions greater than just disability, integrating people with disabilities into a new concept of 'normal'. To finish up, we had an great conversation about creating a new image of the community and everyone left charged to begin the workshops.

To read Andrew's presentation on his work, click here. And we'll be back in touch very soon with news from the first round of workshops in Ciudadela.

Young Volunteer Combines Theater and Community Service at Poly Prep


The price of admission to Poly Prep’s Middle School musical Grease, which was performed May 11 and 12, was backpacks, school supplies, and books in Spanish, which will be sent to children in Tipitapa, Nicaragua.

It was seventh-grader Luke Asente, who played Eugene in the musical, who suggested the nonprofit Sister City organization Dos Pueblos as the beneficiary of the musical.

Asente shared with the school that his mother, Monique Luchetti, is good friends with the Executive Director of Dos Pueblos, Lupe Ramsey,  and that his whole family had joined Lupe and Dos Pueblos on a delegation to Nicaragua in January 2011.

When Asente visited Tipitapa with his family in 2011, he was the first and only youngster to travel with the 15-person delegation, and he said he was “astounded” at what he saw. His mom had the same reaction. “We were blown away by the poverty we witnessed in these small villages,” Luchetti said. “And also by the incredible Nicaraguan people and the strong, generous, community leaders we met. People are hungry, social services are non-existent, there is no infrastructure, no stores or businesses, dogs are starving and children are growing up in the worst of circumstances.” But it is certainly not a place with hope, she says, “Despite all this, the community leaders working there with the help of Dos Pueblos are able to change lives and make a difference to the people living in Tipitapa every day.”

Read the full article here

Marina – a Volunteer Against All the Odds

Marina and Emanuel Life has thrown its lot at Marina Garcia Hortado, one of our dedicated volunteers from Chilamatillo, Tipitapa. Despite all the odds, Marina has always taken it upon herself to improve the lives not just of her children, but of her entire community, providing support such as education on birth control and workshops for women so they can start their own businesses. Not to mention that she’s a fantastic cook!

Her volunteer life began in 1985, when she taught at the local preschool in her community. There was no funding for paid teachers, but Marina understood the importance of free education for all from as young an age as possible and immediately offered her services. However, diseases such as malaria meant many children could not attend school, and in larger families children had to spend their time pitching in to put food on the table. Marina attended courses on malaria and diarrhea so she could share her knowledge back in Chilamatillo, and started working with ‘Profamilia’ who provide programs and services on family planning.

When Marina’s husband Jose lost his sight and could no longer work as a mechanic, Marina took a job at the local primary school to support the upbringing and education of her four children. But this did not impede her volunteer work, and her experiences as a teacher gave her the skills to teach adults how to read and to give private classes to children with special learning disabilities. And since improving the lives of the women in her community was her main priority, she continued to share her family planning knowledge, riding around the community on her bike to distribute contraceptive pills to as many women as she could.

Through working with Rosa, our community leader in Tipitapa, Marina is now assisting our microfinance program, and learnt many skills so she could assist the women along the way – cooking, sewing, handicrafts, even beauty classes! She is our main cook when we head down to Tipitapa on a delegation, and even does a hot plate of ‘gallo pinto’ (beans and rice) better than anyone else. When asked of her dreams for the future, Marina replied “To always have the opportunity to help the people in my community. And perhaps one day to be able to thank the donors of Dos Pueblos in person!”

An Update from the Field: our Health Center is Secure!

By heading to Tipitapa a week before the 2011 Tipitapa Delegation in January, I was lucky enough to really see community work in action with our Health Center Security Fence in Ciudadela San Martin. The entire fence was built in just over a week, all with the labor and support of local volunteers and Rosa, our local community leader and organizer, supervising the project from start to finish. Whether this meant following up on deliveries of supplies or bringing the working team fresh fruit for lunch, Rosa was always present making sure that the fence would be ready in time for the delegates to see, and in time for the planting of our family vegetable patches in the grounds.

With barely a shred of construction knowledge, watching the fence go up was a learning experience. It was also an opportunity to learn some very specific vocabulary (‘malla’ is Spanish for wire mesh fencing). On the day we transported the ‘malla’ from Masaya to Ciudadela, the accelerator pedal in the hired truck gave way. Never an issue in Nicaragua – our driver threaded a rope through the engine, under his feet and into his hand, and just pulled to pick up speed.

Each day saw new progress, with women, men and children helping to create cement mix, chop down weeds blocking the path of the fence and solder the iron tubes in place. The community was supported by CPC (the Citizen’s Power Council) and CAPS, the National Nicaraguan Potable Water Committee on this project, partnerships which can only serve to strength the work we do.

Now our recently renovated Health Center is secure, and the enclosed family gardens are already sprouting radishes and lettuce. Here, parents and children with special needs are working together to grow sustainable and healthy food to support good nutrition, and we also hope to begin workshops in this secure space to teach preventive health. This one, simple project has brought together so much, from community spirit to health and education.