Chronic Pain in Peru

I'm running about 4 months behind here, but wanted to do a re-cap of the third annual Regis University-CMMB partnership trip!

Part I: Chronic Pain Program with Ana Herrera, my hero 

This year we were blessed with another amazing group of Regis physical therapy students and other professionals who came down to Peru for two weeks in August. Similar to previous years, we began the trip with a day exploring the healthcare system in Lima before heading to the northern part of the country. 

Regis DPT students with faculty Nancy Mulligan, local Ana Herrera and program participant

When we arrived, we learned that doctors and many other professionals, including PT's in Peru, were on strike. The physical therapists were on strike more or less in efforts to gain more autonomy in their practice. The hospitals and facilities were eerily calm and mostly uninhabited, and unfortunately we were unable to have a visit with Dr. Leon and his team at the Peru Ministry of Health as in prior trips. As they say, "asi es la vida" in Peru - such is life, so on to plan B!
  
Instead, we were able to spend a day with my great friend and mentor, Ana Herrera. Ana is one of those people that instantly leaves a lasting impression on you. She is an incredibly passionate, intelligent and driven physical therapist who is literally revolutionizing PT practice in Lima and beyond. She's held faculty positions and taught at numerous international conferences, works in conjunction with Health Volunteers Overseas, and is the director of rehabilitation at Hospital Nacional "Guillermo Almenara Irigoyen" in Lima. She's also pursuing her Masters in Public Health on the side!

Ana graciously gave us an impromptu tour of her facility

Ana is a clinical instructor for Peruvian PT students and challenges them to use thorough documentation and evidence-driven concepts, as opposed to passive interventions, with patients. She collects any sort of rehabilitation literature she can get her hands on, and is extremely innovative and creative, hand-making essentially all of the equipment and tools she needs to work with patients. And while all of her colleagues were on a strike for several weeks, Ana insisted on going to work unpaid, saying "I can't just leave my patients!"

Home-made arm bike and rebounder

She has also created an extremely successful chronic pain management program. Chronic pain is an area that seems to both mystify and frustrate most PT's - in seemingly any setting or culture. Peru is no exception, boasting a high volume of chronic low back pain sufferers, and typical treatments are modality-driven. However, Ana challenges the doctors and local standards of practice by empowering her patients get moving through a variety of aerobic and core stabilization exercises, and several group therapy sessions offered each week. She stated, "At first the doctors were angry when I didn't use ultrasound or E-stim as ordered. However, the results of the program speak for themselves." She utilizes cognitive behavioral therapy techniques with her patients based around functional goals, and also aims to provide a jovial community-based atmosphere that keeps patients excited to come back.

Empowering patients through exercise

We were lucky to join in on a group session, which involved games and upper/lower extremity coordination drills on a basketball court. It was clear from our short observation that the combination of group social interactions and skilled/compassionate one-on-one care and coaching worked wonders with her patients. I wish we could clone Ana and send her all over the world! Muchisimas gracias Ana por todo!

Group therapy session