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 :)

Wednesday, August 24, 2011

A first of (hopefully!) many

Centro de Eventos Los Corregidores - Trujillo
August 13-14th, 2011, one of my big work projects here in Peru finally came to life! CMMB and Regis University hosted the “Primera Conferencia Internacional de Actualización en Terapia Física” – the first annual international physical therapy conference held in Trujillo, Perú, created to develop a sustainable collaborative relationship between the US and northern Peru in the field of physical therapy. Secondary aims were to provide quality, affordable continuing education including access to evidence-based updates and criteria in patient management, and to strengthen the unity and leadership within PT’s in northern Perú.
Presenters from the knee group
Morning lecture session
If you haven’t seen prior posts - I began planning the event back in December 2010. Nancy Mulligan, faculty at Regis University, was on board immediately and was extremely instrumental in organizing a group of students and Kristin Carpenter (affiliate faculty) to come down and help with the event. She also helped spread the word, and Alec Kay (Anchorage, Alaska) and Ommar Ortuvia (Houston, Texas) committed to volunteering as presenters. We felt it was important to have a team of both Peruvians and Americans involved, so we sought out local leaders Ana Herrera (Lima, Peru), Pedro Rojas (Trujillo, Peru) and Pedro Romero (Lima, Peru), to present as well. The event just kept gaining momentum – and before I knew it, I had people calling around the clock from cities near and far to find out how to sign up!
With Dr. Leon (Ministry of Health) and Dra. Llanten (CMMB)
Participants from Chiclayo, about 3 hours north of Trujillo
No matter how much you plan ahead here in Peru, there are always last minute changes and frustrations. I was lucky to have a whole bunch of volunteers involved and great support from CMMB, or event planning would have been a lot more stressful! We certainly experience a few little momentary “setbacks,” such as…

- 1 week before the event, our restaurant/bar lined up for the reception of 200+ people tried to back out, even though we’d already paid the deposit. We received an invoice for event costs from the event center that was different than our calculations. Claudia’s luggage was lost, which had a number of different materials for the event. We had problems with a speaker of one organization who needed a new official letter in order to come from Lima. Customs in Lima almost confiscated the entire 4 bags of conference equipment donations.
- A few days before the event, the custom-made event bags for participants were still not in Trujillo - 1 week after they said they would arrive.
- The day before the event, I received a call that one of our Lima presenters had missed her flight! And one hospital that was supposed to lend us a large quantity of treatment tables for labs suddenly was suddenly unwilling to give them to us, despite a written contract. One of our other presenters was MIA and didn’t show for the welcome dinner.
- During the event, our person to give the opening remarks did not show. The presenter who missed her flight made it, but late, so we had to shift some things around. There was one chaotic coffee break mix-up, where one group was accidently let out at the wrong time. One day, the MC’s didn’t show – so I spoke for them.

ETC ETC! But- “asi es la vida” here in Peru. (And of course these types of things happen anywhere.) 

Afternoon lab session
Presenters of the cervical spine group
All in all, the setbacks were minor and the success was huge. We had nearly 200 participants who were split into two groups- neck pain and knee arthritis – two of the most common outpatient conditions seen here. We included “labs” both days to practice techniques, a rare opportunity for Peruvians. The labs were a bit chaotic, and the lectures were a bit heavy with material- but from an organizational perspective, we learned a lot and got some great feedback on how to change the event in future years. 

Presenters and Regis students teaching labs
Participants received DVD’s with powerpoints and videos of lab techniques, and their bag (came just in time!) complete with therapy equipment. The event included different breaks for networking opportunities, a cocktail and appetizer reception Saturday night, and a catered lunch Sunday with a dynamic discussion led by Peruvian PT’s from my focus group. We discussed some of the challenges facing rehab. providers – with a high caseload and short time with each patient, how can we incorporate more exam components into a new patient session? How can we as PT’s be more involved in the prevention aspect of healthcare? And how can grow more unified and organize ourselves as a community of PT’s in northern Peru? We came away with a list of 125 people who are interested in creating a national organization of PT’s, aids and students, similar to the something like the APTA in the U.S., who also voiced interest to work together to improve opportunities for persons with disabilities.
Enjoying the reception Saturday night
No cocktail night complete without a spine manipulation! (I swear, this was not staged!)
Saturday we invited leaders of local academic institutions to a lunch discussion over potential teamwork with CMMB and Regis University in a community based rehabilitation project. I’ll elaborate on this project later, but it was a very positive conversation and I plan to do everything I can to strengthen this relationship between now and when I leave.
Networking lunch on Sunday
One of the big challenges of the event was that it included 18-year-old students in their first semester of studies, all the way to 50+ year olds who have been practicing in the field for decades. Thus, within the participants we had a wide range of skill sets and experiences. A big emphasis in the event was the practice of basic exam skills. We also had to tread carefully in treatment with the teaching of manual skills over such a short time frame. From my experiences, I can affirm that Peruvians tend to focus almost entirely on modalities in physical therapy treatment, so we tried to address this delicate topic throughout the event by saying “Hey, since you have such limited time with each patient, how about this exercise or manual technique over the machine – more bang for your buck.” At the same time, the whole idea was to share knowledge and ideas – a two-way process – and I hope that we were able to do this without coming off as all-knowing or superior in the presentation of materials. 

more lab practice time
The event design and organization certainly had many flaws, and realistically 1 two-day course cannot change clinical practice drastically. It may be putting a “band-aid” on an evidence-based knowledge gap that is rooted in flaws in the curriculum of the local academic programs – but I like to think it’s more like one of those awesome “liquid” band-aids – the ones that fill in the cracks to create a clear, breathable seal. I know it’s not the complete solution to changing practice patterns in Peru, but I believe that it’s an important piece of the puzzle on many different levels. 

Coffee break during event
As I jumped back and forth between auditoriums to observe groups throughout the weekend, and through many conversations during the event, I was really touched by the very positive responses across the board. People came up to me in tears to thank the team of volunteers. I saw glimpses of hope and sustainability – changes in comfort levels with hands-on skills, changes in critical thinking skills, and changes in social networks. I overheard discussions on how the PT’s plan to teach their peers and co-workers what they learned at the event. I think that the event was an important tool – be it a baby step - in changing clinical practice- but I believe that it also managed to bring more unity within the PT community. And I have high hopes that it is the beginning of a strong collaborative relationship between the US and Peru.
Presenters, translators and event focus group
After the event, I had a couple of nights of 10+ hours of sleep and got back in the rhythm of nice, long, relaxing evenings in with my host family. I couldn’t believe how physically and mentally exhausted I was! However, despite 10 months of work, complete with challenges and periodic frustrations, it was all completely worth it. So, after a 48-hour recovery period, I couldn’t help myself - I started looking at the evaluation forms and – call me crazy – planning for next year. ☺ Any PT’s out there interested in coming down for the Segunda Conferencia Internacional de Actualización en Terapia Física - August 2012?

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