We’re working with Adam, a 33-year-old Hungarian who was working in the UK when he was hit by a car, sustaining catastrophic injuries. This earlier blog gives the background to the case. In this post Anava Baruch, our MD and Clinical Lead, looks at the challenges of helping him return home to Hungary.
Helping Adam home to Hungary
We know that Adam is keen to return home to Hungary, and it’s my role to make that happen. But I’ve never visited Budapest before, let alone helped someone with complex care needs move there.
Early on in the project it soon became clear that there were many basic things I didn’t know:
- the types of houses that are available in Budapest
- how they’re constructed, and how that affects how we could adapt them
- whether people generally live in houses or flats
- where a young person like Adam would live.
The power of local knowledge
So what’s my strategy?! I know Adam has a lawyer in Hungary who speaks English so I start there, asking tons of questions of both the lawyer and Adam’s family.
I quickly learned that Budapest is divided into two cities. Pest is flat but it’s the business area, and people prefer not to live there. While most people live in Buda, it is hilly and there are lots of flats. However, my desk research showed that they tended to have lifts, so that could work for Adam.
Armed with this knowledge I flew out to Budapest to view some properties. It quickly became clear that we had to think again.
While the flats had lifts, not one of the lifts I saw was big enough to accommodate Adam’s wheelchair. Ground floor flats were also out of the question. Because of the cold winters, parking was always underground and the lifts up were equally small.
Part of the reason to look for a place in the city centre was Adam’s mum. She lived in the centre of Budapest, and it was clear she was going to live with Adam. Once we established she was happy to move out of the centre we knew we could start thinking outside of the box in terms of search areas.
Adam’s mum gave us some guidance on areas she wouldn’t like to live. We then came upon a district in Buda, called District 3. It’s a popular place for holiday homes and has a lot of bungalows, unlike the city centre.
I returned home and the solicitor acted as my eyes, visiting a number of properties and taking hundreds of pictures from every angle so I knew what I was looking at.
We finally hit upon a property we thought would be perfect for Adam, with the necessary adaptations, and the owner was happy to work with us.
A different way of working
My next learning curve was the realisation that building and adapting properties in Budapest is a nightmare!
There’s no contract, there’s no agreement on how much things will cost – it’s a rough estimate that usually goes twice as high. There’s no penalty for late completion, and there isn’t warranty for work. So how do you find a builder you can trust?
I was really lucky, as the vendor had built the house himself and so knew the architect and builder that did the work. Just by walking through the house I realised that the builder knew what he was doing, and I’m pleased to say that we’ve been able to get them involved in the project.
The house is two-storeys, with the garage on the ground floor and accommodation above. The main access to the main living area is via steps at the side, so we’ve had to find a different way in and are changing a window to a door, which Adam will be able to drive up to.
Work is progressing nicely, and we’re overseeing the adaptations to ensure that the builder adheres to our specifications.
Sourcing support and equipment
However, having the house is only one side of the equation.
While I know exactly what equipment Adam needs to return home to Hungary, is it actually available? When we started asking questions I realised that most people with the same injuries in Budapest would not survive the accident. This means there’s no equipment market to support clients.
While we could ship equipment in from the UK, who would maintain it? Adam needs a whole host of items, from hoists, to shower chairs, slings and hospitals beds, and all of them need regular servicing.
I found a company that provides equipment to hospitals. So we have a hospital bed, air mattress, mobile hoist and overbed table.
This is a good start, but it’s very basic, so we’re now sourcing the rest of the equipment that we need and bringing it to Budapest.
We went wide and far and talked to so many suppliers of ceiling track hoists in the UK. Guldmann have been great, and they contacted us and said they had a guy in Germany who could get involved. We’ve since met with him in the house and now have a quote for ceiling track hoists for all the areas, which they will install and service.
We can’t source a shower chair in Hungary, so need to find something that will need virtually no maintenance, that can be manually tilted, and has a very robust frame that you can’t break. Following recommendations from the rehabilitation centre in the UK, we are now exploring the use of the Raz chair.
Finding a wheelchair
For me the wheelchair is probably one of the most important pieces of kit. If I don’t provide the right wheelchair for Adam he’s not going to be able to leave his house.
We’re working with Better Mobility who can provide a basic manual wheelchair that will never break, and a really expensive electric wheelchair that will go up and down pavements, through snow, into the garden and do everything else we need it to.
The supplier has agreed to visit Adam to service the wheelchair, and we’re currently trying to teach Adam to use his own joystick so he has control.
Getting Adam and his wheelchair out into the city is not so easy. An equality law was passed in Budapest in 1998, and everything that is new is deemed to be accessible.
However if you ask wheelchair users, or look at online reviews from wheelchair users, they all say that only some parts are accessible. This means you don’t know when you go to a place if it’s going to be accessible till you get there.
My initial reaction was that we needed an accessible car with an electric wheelchair, and that would solve the problems. But does that exist in Budapest? Of course not! Should I give up? Of course not!
A tough challenge
The car has proved one of our tougher challenges. It needed to be registered in Hungary, but there was nobody in the country that could adapt it for us. We spoke to companies in the UK and asked whether they could go and assess Adam’s needs and come back with what we need to do, and they couldn’t.
We spoke direct to Brotherwood, and they suggested that we register the car in Hungary and bring it back to the UK for them to adapt, and then drive it back to Hungary.
After hours and hours of research we finally found a supplier in Austria. They said they could adapt the car in Austria, which is just a three-hour drive from Hungary.
The final piece of the puzzle was manual handling. Within the Hungarian domestic setting, manual handling is based on people being physically lifted by their carers and family.
We all know how dangerous that could be for someone in Adam’s condition. In the long term it would have serious impact on his carers’ health.
We’ve now arranged for manual handling training and assessment to be carried out by an OT from the UK. They will fly over every year to review the case and check the equipment. The case manager and Hungarian solicitor will play a key role in alerting us to any problems that arise.
A rewarding experience
While this case has been incredibly challenging, it encapsulates everything that I love about being an OT.
We can think out of the box. We can break rules. We can look at the situation holistically. We can empower our clients to live as independently as possible.
We can make things happen. Including getting Adam home to Hungary.