One Year. One Physical Therapist in Trujillo, Peru.

Combining passions of global public health with travel and cultural immersion... With the help of the Catholic Medical Mission Board, I was afforded the opportunity to live outside of Trujillo, Peru for one year's time (2010-2011). Check out old posts about my experiences as a PT working in hospitals, a school, an outpatient clinic, doing research/community based rehabilitation, and a little teaching too. And my experiences with an entire calendar year of holidays, cultural customs and new culinary experiences!

I make it back about once a year with university students/CMMB projects, so I will periodically provide updates :)

Monday, January 31, 2011


I think that one of the most challenging parts of being a long-term medical volunteer is in finding an effective supplement to patient care that will leave a continued lasting impact on the community. This one little word signifies social justice over service, digging to the root versus putting a band-aid on the branch.

To me, it also signifies cultural awareness and the importance of research. You can spend a lot of time and resources allocating, for example, small stoves to boil water in order for a community to gain potable drinking water, but if they are too poor to afford the gas, what’s the point?

I am very fortunate in that a part of my work schedule each week is set-aside for exactly that – public health work that (hopefully) translates to sustainability! The hard part, however, is in knowing where to even begin, especially in a community abundant with healthcare needs and disparities. I’m also very lucky to have one of CMMB’s staff, Claudia Llanten, based out of Trujillo, who has been an incredible force of change and progress in several communities here in Perú. She’s helped me to narrow my focus into a few specific areas and I’ve already learned so much from her mentorship.

“Rehabilitación con Esperanza” is a community-based rehabilitation program that you’ll be hearing about in the months to come. I’ve already touched on a few of the components in previous blog posts. Basically, in a nut-shell, the project entails two main focus areas…

Needs Assessment and Subsequent Action Plan
As a whole, Perú lacks published data/studies on the statistics of health indicators and factors related to disabilities. In my community, we get a glimpse into common conditions based on the population who come into the clinic, but with barriers such as transportation and money, I suspect that we only see the tip of the iceberg.

This month, we are beginning a pilot study of a household survey created to assess not only disability prevalence, but factors related to access and quality of life. This is the first survey of its’ kind here that addresses characteristics of the home environment, transportation, work, social activities, social assistance, community mobility/assistive devices, functional activities, and health beliefs/opinions in the lives of individuals who have disabilities. I based the ~100 questions (adults) and ~70 questions (children) on a combination of a selection of ideas from the National Health Interview Survey on Disabilities (from the US) and on other cultural-specific areas of importance.

We will begin with the use of a pre-existing basic survey assessing the home/family environment (does the home have electricity, a bathroom? Etc.) The volunteers will then return to the homes identified as having one or more persons with disabilities to conduct the longer survey. Following the pilot study, we’ll conduct a larger sample of all of the homes in the district. The idea is to then use the information to create an action plan targeting the more common conditions in order to provide programs for both treatment and prevention. If successful, we also hope that this tool will then be applied around the rest of the country.

Improving Access to Evidence-Based Physical Therapy Practice
The other area of the project is focused around educational tools for healthcare providers, mostly physical therapists. A number of discrepancies exist between the profession of physical therapy in Lima and the northern region of Peru. Generally, a concentration of resources are centered in Lima, including opportunities for higher level education (a difference of two years) and access to continuing education resources such as short courses and conferences. It’s also evident that there’s a lack of communication, organization, and unity between physical therapists/tech’s in the north. From observations, physical therapy services offered in my area are mainly based around electrotherapeutic modalities, and documentation is scarce, often non-existent. There’s a high interest in learning techniques of quality evidence-based practice standards, yet most of the available studies related to physical therapy are in English.

Each month, I teach a course to groups of physical therapists in my area in efforts to improve access to desired educational materials. I’m also beginning short courses with one of the local hospitals, and planning a bigger physical therapy conference in Trujillo for August 2011. I’m working on providing a number of Spanish physical therapy resources on the internet, and attempting to shift the standards of documentation here. I have a focus group of physical therapists here in Trujillo, and one in Lima, in the hopes that I will have the best interest of Peruvians in mind, and also in the hopes that these efforts will continue after my time of service here.

I’ve also recently become more involved with the Ministry of Health, and they’ve asked me to work in Lima a few days a month in order to present my observations and community based rehab program. This means that I can shift some of my frustrations with the quality of physical therapy here into more productive, (hopefully) political action! I am so excited about this opportunity, and for the potential sustainability in both areas of the project.

Now, I’m asking for YOUR help… I’m pretty new to public health work, so please post or email comments with ideas, suggestions, feedback, etc!

Thursday, January 27, 2011


My first pen-pal, in the 5th grade, lived in the Midwest and all she wanted to write about were igloos, Eskimos and polar bears. It was a short relationship.

I am happy to announce that I now have not one, but 30 new pen-pals! A 7th grade class in Rumson, New Jersey has graciously decided to stay in touch with me during my year in Perú! We met briefly after the school put on a banquet during our CMMB training week in August. Their letters are fantastic- they make me laugh, a few make me cry (in a good way) and they are very humbling- and I just want to give a big shout out to the
You guys are awesome!

Thanks for being my pen-pals! ☺ You are doing a much better job than my first pen-pal. Your questions are really intelligent and thoughtful and I’m very impressed! THANK YOU for all of the kind words and support. I have started to write back to each one of you, but it could take a little while… so be patient!

Sunday, January 23, 2011

In Loving Memory

The world lost an amazing person today, but heaven gained another.

In loving memory of Deacon Ken Donohue…

Who has been an inspiration in my life since I was a little girl. He always lived by example, lived a life of deep spirituality, family values and self-less service to others. Though he may not know it, Ken has been a big source of personal encouragement, especially during difficult times and challenges I’ve faced here in Perú.

A few months ago, he shared his favorite Bible verse with my family:

As long as I live, I will sing and praise you, the Lord God. I hope my thoughts will please you, because you are the one who makes me glad.

-Psalm 104:33-34

Without a doubt, I can still hear his song and praise. He will continue to inspire me throughout my life.

Sunday, January 16, 2011

You've got mail...

I’ve had a few interesting encounters with the Peruvian post office, or SerPost, since I’ve been here. One day, I went to mail some postcards (which ended up costing over 2 dollars a piece! Wow! That’s a 6 hours’ wage here - just to mail one!) There are a number of men in uniforms armed with guns all around the place. I paid for my stamps and then was completely confused as I could not find the mailbox ANYWHERE! I finally asked one of the armed men, and he laughed at me and said, “la boca del león” which means the lion’s mouth. Even more confused, I wandered around looking for anything resembling a mailbox with a lion on it, until he guided me toward his decorative thing off to the side. It was a giant unmarked bronzed lion’s head and you drop the letters down the mouth into a cardboard box. Not sure how I missed that.

The second time, I went to pick up a package. After several sets of doors and showing my identification to armed men, I arrived at the back of a 20-person line. 2 hours later… I was still in the line. It was hot and lacked personal space. The same three ladies kept repeatedly trying to cut in front of everyone. Every package had to first be located from the storeroom. I caught a glimpse of the storeroom from time to time – a large room with a religious shrine in the center surrounded by thousands of letters and packages piled in up in bags and on the floors. It looked like pure chaos. (But, the Virgin Mary did create a nice ambiance for the room).

Once you made it to the front of the line and they located the package, you had to sign all these forms, show your passport, give them two copies of your passport (??) and watch someone cut apart the box and take every single thing out to inspect it. (The inspector lady cut her finger in the process so one package left with blood all over it! Then after that, the process was severely slowed because she had to do everything with one hand.) Finally, you sign some more things and off you go with your package! Getting the package home is a whole other adventure- do you risk it getting stolen by taking public transportation, or risk worse things by getting into a cab alone? I took public transit and then bolted the two blocks to my front door… mission accomplished!

*A special thanks to those who have sent me care packages! You are AMAZING!*

Sunday, January 9, 2011

What is a muscle?

The other day I was explaining pathology to a patient in the outpatient clinic and she interrupted me to ask, "What is a muscle?" I am not trying to be funny - such questions are not all that uncommon in my everyday clinical practice. (And YES, I know how to properly pronounce "muscle" in Spanish!) Lack of financial or transportation resources affect my patient care and progress, but a generalized lack of education is another key challenge I face in my work here. Thus, patient education begins at a very basic level.

In addition, the concept of going to the gym or working out to promote health or lose weight is especially foreign in my community. My patients associate all muscle soreness (following exercises) with a worsening of their condition. Many have a pre-conceived notion that PT will be a long massage followed by the application of a machine or two, which is what PT services often consist of here. Imagine their surprise when I introduce concepts like manual therapy, functional training, and home exercise programs into their plan of care!

The outpatient care can be quite frustrating, because in general Peruvians treat their health in “responsive” mode and are not proactive or engaged in preventative care. If they have unbearable pain, they come in, but the moment it starts to go down, they tend to stop coming- generally citing that they can’t afford it. It's common to have a patient suddenly stop coming, but then they’ll randomly stop by weeks or months later asking for a session! Of course, this doesn’t happen with everyone, and the patients who are better off financially rarely miss a visit.

At first I worried it was my “unconventional” therapy techniques – but I’ve had a lot of feedback from patients and their doctors, and colleagues at the clinic insist that it’s a cultural thing- this is normal. The expectations for all types of medical care seem to be "one-stop shopping" - a quick fix. Thus, it’s hard to gauge success and it turns into a chronic pain cycle for many patients, because they only ever reach the point of a semi-functional status. “Make every visit count – who knows when I will see this patient again!” seems to be my motto. Hence, I spend a good amount of time on patient education and ensuring a good home exercise plan basis.

The mind-body connection is very noticeable in my outpatient care experiences. Depression and stress are common, and life is hard for the people of La Esperanza – it’s written all over their faces. Many of my patients confide all sorts of things in me, and I really get to know their stories and their lives. Sadly, many stories involve physical abuse, insurmountable health co-morbidities, death in the family, etc. For most, injury = no work = no food for the family, so you can imagine the psychological impact this can have on one's well-being. It seems that simply by providing an empathetic listening ear, many are already 50% better physically by the end of the session. I’ve also had some unusually rapid successes with certain patients after just one session of manual therapy – there’s definitely something to be said about the power of human contact!

Tuesday, January 4, 2011


Happy 2011! Time for some shout-outs...

I want to take a moment to thank you for tuning in – and especially those of you who have sent letters, packages, encouraging emails or facebook messages – and of course, the skype dates. Your words brighten my days and keep me going. THANK YOU so much!

Especially want to acknowledge…
My mom, dad and sister Britt
Mi Familia Peruana (no se si estan leyendo? Gracias por todo el apoyo aca en Perú!)
Aunt Michelle, Uncle Kevin, Ian and Maria Donahue
Aunt Kathy, Uncle John + Ryan Stroyls
Auntie Helen
Uncle Steve + Aunt Dottie Connolly
MaryJane Gallo and The 7th grade class at Holy Cross (Rumson)
Cathleen Daly - for her unwavering (on the ground!) support
Uncle Keith, Aunt Pam and Crystal Walker
The Chapmans
Deborah Harris
Father Scott and Maria Elena Medlock
Rob Smith
Jules Johnson
Lindsay Palaima
Ashley McKee
Mary Kaye Dolan
Catherine Engibous
Michelle Saltmarsh
Keri Vonkalinowski
Layna Shorter
Susy Mercado – Thanks for the wonderful family welcome!
Regis faculty and my DPT class of 2010
My friends at Black Lion Hospital in Addis Ababa, Ethiopia - Tes Fekadu, Nigatu Abate and Mengestie Mulugeta
Fellow CMMB volunteers out there in the field! Keep up the great work!
And anyone who’s commented on the blog posts too!

Hope I didn’t forget anyone… Many thanks for all of your love, prayers and support! ☺