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 :)

Saturday, August 20, 2011

A change of pace

I’ve just finished a whirlwind couple of weeks with a group of volunteers from the US. Regis University sent down 6 students and 1 affiliate faculty as part of a service-learning type trip working in conjunction with some of CMMB’s projects. We started planning it all back in – whew, December I think?! So it was great to finally have the group down here and put them to work. And work hard – they did!

Sunday evening myself and another CMMB volunteer met the group in Lima. On Monday we toured the hospital ESSALUD – Almenara facility with Lic. Ana Herrera. Ana has been one of my biggest mentors during my time here in Peru. During her career, she has transformed– literally from scratch – an underfunded outpatient clinic into a great resource of evidence-based PT practice for Peruvians. She is one of the few Peruvian PT’s I’ve met who focuses on manual therapy and exercises over electrotherapeutic modalities. Creativity is one of her great strengths, as is evident from a number of home-made therapy exercise devices. Ana is constantly seeking out literature on her own in order to stay up on the latest treatment techniques. She gave the group a tour of her facility and an introduction to a number of challenges inherent in the current healthcare system.
From there we headed to INR – Instituto Nacional de Rehabilitación – which is known as Peru’s one-of-a-kind model for quality rehabilitation services. INR has applied a community based rehab program in their community near Lima. Things I like – a team approach within different medical specialties, state of the art equipment and lots of space for PT services, workshops for job training, and an onsite center where people with disabilities have been trained to make prosthetic devices.
However, I’ve gotten to know the center and staff through visits and various meetings in Lima, and I do see some weaknesses with their approach. For one, they’re not very open to sharing – ideas, resources, documentation, etc. They insist that they must “validate” every form or resource that they create – a process that takes on average 2 years. For example, they wanted to “validate” and then implement an infant developmental milestone chart with the ministry of health. Instead of turning to charts that already exist, they created their own, and then spent 2 years “preparing it.” Now it’s supposedly “implemented” in all of the ministry of health facilities- though I have yet to see the same chart in any of the health facilities I frequent. Not the best use of time and resources. Another weakness is that their system is not very replicable for Peru – they train outsiders to refer people to their facility in Lima – but what Peruvian can really afford the trip to Lima and all the associated costs? There’s certainly a huge problem in Peru with most of the healthcare resources centered in the capital, Lima. I find all of this very interesting since I’m currently working on my own community based rehab project plan – but, I digress…

After lunch Monday we spent the afternoon with Dr. Luis Leon, the executive director of integrated healthcare for Peru Ministry of Health. Dr. Leon has been a huge supporter of CMMB’s work in Peru and I’ve been lucky to spend a lot of time in meetings with him throughout my year here. We skyped in Nancy Mulligan, professor at Regis University, who put the students’ trip together. The group learned about the current healthcare system in Peru and the disability statistics, and the goal of universal healthcare by 2015. Dr. Leon proposed a sustainable relationship with Regis in the form of academic support. Specifically, he asked Regis to create protocols/a review of the current best evidence across ten different common pathologies here in Peru! An exciting opportunity – more on this later.
That evening we headed by bus to Trujillo, and Tuesday morning we toured Colegio Santo Toribio, a school for kids with disabilities in a poor community near Trujillo. The school follows the Montessori approach and focuses on empowering kids with independence and functional skills for activities of daily living with the ultimate goal of integration within the community, job skills and employment. In addition to academics, they provide physical therapy, meals, skill workshops/training including a bakery business, carpentry, and jewelry making. The school has a several-year wait list and a very compassionate, talented staff.
From there we visited a part of La Esperanza called Nuevo Jerusalen, where the living conditions and sanitation are poor and people face daily challenges with things like crime, lack of water, and no access to healthcare.
In the afternoon the group (ahem… mainly Kristin!) ☺ led staff of Clinica Madre de Cristo through an exercise class! We had some technical difficulties with the video equipment, so we ended up winging it and doing a cardio circuit followed by stretching and abdominal stabilization exercises. The Regis group stayed at the convent attached to the clinic and the nuns invited everyone to a delicious welcome dinner that night.
Wednesday we headed up to Puesto de Salud Bellavista, where we split into groups to do physical therapy initial assessments with a group of older adults. We offered to see 20 people… which, not surprisingly, turned into 43 people signed up and waiting in line! I think the students were a bit overwhelmed between the language barrier, facility, time constraints, and other cultural factors, though it was a good learning experience for all. The hardest part for me was seeing a number of heartbreaking, complicated cases and feeling a bit helpless, seeing as how these people would not likely have any follow-up care due to financial constraints. One can’t help but compare the situation here to the US and how much different their quality of lives could be if they were on another side of the world.
That afternoon we toured Hospital ESSALUD Albrecht with one of my colleagues. We were able to see the emergency room, post-surgical, and maternal health parts of the hospital. We toured the outpatient PT part of the hospital, which in this case was in a 3-story home near the hospital! It was quite the contrast from what we saw in Lima, and the students observed first-hand the strong reliance on massage, ultrasound and other modalities for PT treatment here.

Thursday we headed to a community called Cambio Puente, outside of Chimbote, about 3 hours from Trujillo. CMMB has a public health project there targeting mothers and children under the age of 5. Partnering with the Sembrando Infancia team, we went out in groups doing home health visits. It was an eye-opening experience, as many of the homes have dirt floors and no bathrooms, water, or electricity. The students were deeply moved after seeing patients who were neglected or not provided with resources to reach their full functional capacity.

Friday we finished up some preparations for the continuing ed conference and then went to another CMMB-sponsored event – a Community Based Rehabilitation congress. The event included a number of presentations, and at the end a discussion on how to move forward together as a team between the different non-profits and leaders of the Ministry of Health present. For me, the discussion was a bit frustrating – as there was a lot of talk but no concrete changes or big action plans. This is one of my big pet peeves with Peru – everything appears so formal on the outside, but where is the progress? Peruvians almost never say “no” initially to something – so many things end up falling through. I hope that this group of leaders will show more initiative and that it won’t be empty promises. Nonetheless, it was a positive event and a week packed with activities for the Regis group!
The students shifted into hands-on teaching roles for the weekend, in the 1ra Conferencia Internacional de Actualizacion en Terapia Fisica. [I’ll save comments from the International PT Conference (Sat-Sun) for my next post.] After the conference, we had a couple days to relax and surf in the beach town of Huanchaco

I had a great time sharing Peruvian communities and culture with the group (not to mention wining and dining them at all of my favorite restaurants!) We were lucky to have an extremely energetic, dynamic group of students who were open and flexible, asked great questions, and didn’t complain - even after 16-hour work days! All in all, the trip was a huge success and I’m excited about the potential for a sustainable relationship between Regis, CMMB, the Peru Ministry of Health and other local academic institutions.  

Special thanks goes out to: Kristin Carpenter who came down with the students, Nancy Mulligan for all of her invaluable planning, Hermanas del Buen Soccorro for offering lodging and transportation, and Cathleen Daly & Claudia Llanten who helped with the group activities.

Now I’m having some serious group withdrawals – I keep looking for our bus (and drivers…), gazing around instinctively like a mother hen to make sure we haven’t lost anyone, cracking jokes in English over my shoulder to strangers, and fantasizing about what dessert we will have next.
Thanks Regis students for coming down - MUCHAS GRACIAS a Megan Daly, Jenna Neff, Laurel Proulx (Lor-ell..Proo!), Megan Kelly, Erin Carpenter, and John Zapanta! (And, Gracias.. A..Dios!)

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