New Beginnings: Huancayo, Peru

A recap of the 4th annual Regis DPT program service learning trip in Peru: August 2014

Every year as we return to Peru to team with CMMB (Catholic Medical Mission Board), I marvel at how much we learn and continue to evolve within our short term mission trip model. This 4th annual trip was no exception.

After hosting three international continuing education events in northern Peru, last year we began to shift our focus from a continuing education model to a bigger focus on community based rehabilitation. Northern Peru has had a large growth in the number of continuing education opportunities offered in recent years. While the conferences the past three years in Trujillo were valuable in a number of educational and community building ways, they weren't as sustainable as going to the source and focusing on teaming with local universities in curriculum development.

From an itinerary perspective, we felt that the experience would be more enriching for everyone involved if the Regis students had a more focused experience of several days with just one community partner. We also began to shift our focus as CMMB's needs changed. The initial community based rehab. (CBR) project "Rehabilitacion con Esperanza," based out of Trujillo, was having great success and no longer requested additional training as it is currently self-sustained by the amazing efforts of the local volunteer team. Best of all- due to CMMB's success in Trujillo, they decided to begin a similar model CBR project in a new location!

So, in August of 2014, 9 Regis first year DPT students, professor Nancy Mulligan, myself, Regis alum Amy Forsman, and translator Maria Roldan headed to the highlands in northern Peru, to a city called Huancayo. Huancayo already has a CMMB team in place who work with mothers and children under age 3 in different aspects of health, nutrition, hygeine, prevention and early stimulation. The team identified over 40 children in the area who have disabilities. We went out in small groups doing home evaluation and treatment sessions with the children and their families. The population demographics varied with diagnoses ranging from CP and Down Syndrome to severe juvenile rheumatoid arthritis, wound infection, orthopedic complaints such as rib pain, tibial torsion and pie plano, mental retardation, speech and motor delay, etc. Groups paired with with local a PT and speech therapist in individualized evaluation and treatment sessions. We also collected baseline data for research and monitoring/evaluation purposes. We rounded as a large group with certain cases and I was impressed by the preparation of the Regis students and their willingness to jump out of their comfort zones in many situations. We were extremely blessed to count on the leadership and guidance of Amy Forsman, an extremely talented pediatric specialist who joined us on the trip this year.

Even though I've done this trip four times now, it's still hard to put into words the depth and impact of what we saw and experienced. For some of the students, it was their first experience with extreme poverty. (This year, the photos won't do it justice, as I did not take any while we were in patient homes). The community welcomed our group with open arms and we were blown away by the love, family values and happiness we encountered despite some extremely difficult socioeconomic situations. Due to location (most specialists are in Lima) and financial reasons, many of these families had never taken their child to see a doctor. On our last day in Huancayo, CMMB threw a fiesta in the park with all of the families. Many parents were hesitant to go, commenting that they had never brought their child who has a disability out of the home before - ever. That floored me.

The fiesta was a day of laughter and games and community building. None of the parents knew eachother beforehand, despite being neighbors, and I hope that the project will serve as a form of social support for caregivers as it moves forward.  We felt honored to be included in the start-up efforts of this CBR project and are really excited about CMMB's passionate new PT/SLP team that's already in place in this community. They are there day in and day out, walking from home to home to make sure that these children receive the rehabilitation services they need. And, hopefully someday, the assistive devices, pharmacological management, psychology services, occupational therapy, educational inclusion, workshops with community agents, and other specialty areas that CMMB's other project has encompassed in northern Peru will be available to these incredible families.

The service learning trip also included a visit to a hospital in Lima with my hero Ana Herrera, a PT who runs a chronic pain program. We were invited to the ESSALUD hospital in Huancayo, where we made new contacts involved in academia who invited us to return and potentially partner together in the future for educational events and student exchanges. Nancy and I were invited to speak at a private clinic and foresee a great potential for multiple international clinical rotation sites in Huancayo in future years.

Of course, no trip to Peru is complete without sampling local ceviche! (and other tastes of customs and culture). The students went to Machu Picchu, and while in Huancayo we experienced Peruvian highland traditional art, food, history, and some high altitude hiking.

A huge thanks goes out to Regis University, and in particular Nancy Mulligan, who devoted a large amount of time in logistics and preparing the students for pediatric cases this year. Thanks Amy Forsman for your compassion, superb expertise and teaching skills, and for joining us on such late notice! Thank you to our amazing student group: Arturo Carillo, Ashley Leatzow, Ashley Sloan, Dani Hill, Jordana Saliman, Kelly Farrell, Matt Sullivan, Mikayla George, Tess Slapper.

MUCHISIMAS GRACIAS to CMMB and in particular Claudia Llanten, Cecilia Izarra, Merci Orbegoso, Carmen Rodriguez, and Lorely Martinez. Thanks to Ana Herrera and Dr. Jorge Soria Gonzales for welcoming us to your hospitals and clinics.

Thank you to everyone at Samay Hostel for your hospitality and lodging in Huancayo, and to Maria Roldan for your invaluable translating skills!

Regis DPT Program: Peru Trip 2014 - Huancayo

August is nearing and we are in full-force preparation mode for the 4th annual Regis University Doctor of Physical Therapy program service-learning trip to Peru! We are continuing to partner with Catholic Medical Mission Board, as in years prior, but this year we are no longer offering a continuing education event in Trujillo because we will not be in that part of the country. We've also begun to shift our project focus away from continuing education and more toward partnering with local universities.

Because the community-based rehab (CBR) project "Rehabilitation with Hope" is now fairly self-sustaining in northern Peru, CMMB has asked us to assist them in a completely different part of the country in the beginning steps of the implementation of a CBR project based off a similar model. Regis faculty Nancy Mulligan, 9 Regis DPT students, Regis alum and pediatric specialist Amy Forsman, and myself will be traveling together to the mountainous region of Huancayo which is located roughly east of Lima, sitting at above 10,000 feet elevation. The primary focus will be in working with up to 40 kids who have disabilities and their families in home visits to perform initial evaluations, create an individualized plan of care for each kid, and to then follow up with the implementation of physical therapy with local PT's and SLP´s, PT students, community volunteers and families/caregivers.

Can't wait to meet the whole team and get going on this new adventure!

A special thanks for continued support from: Regis University DPT Program, CMMB, Instituto Nacional de Rehabilitacion, Claudia Llanten, Nancy Mulligan, Amy Forsman, Ana Herrera, and Maria Roldan.

Links!

CMMB - Catholic Medical Mission Board:
http://www.cmmb.org/cmmb-peru

Dr. Llanten's incredible commitment to public health in Peru:
http://www.whitehouse.gov/champions/strengthening-food-security/dr.-claudia-llanten

CMMB Publication:
https://apha.confex.com/apha/142am/webprogram/Paper309348.html

You Tube video by Andres Gomez: CMMB's work in Peru
https://www.youtube.com/watch?v=GcQAYQ139A0&feature=youtu.be 

Regis University DPT Program:
http://www.regis.edu/RHCHP/Academics/Degrees-and-Programs/Graduate-and-Doctorate-Programs/Doctor-of-Physical-Therapy.aspx

Rehabilitation with Hope

One of my favorite parts of our annual trip down to Perú is to see the progress in the community based rehabilitation project, "Rehabilitación con Esperanza" (Rehabilitation with Hope). Since I was involved in the ground work for the project when I lived there starting in 2010, with all the blood, sweat and tears involved (haha. sort of serious) I'll admit that I consider it "my baby" in a way. Each year I see incredible advances in the quantity and quality of services offered, and other organizational components such as monitoring and evaluation, all thanks to the incredible initiative of doctor Claudia Llantén and a team of amazing local volunteers.

Dra. Claudia Llantén, CMMB's director in Perú

The project's focus is on children who have disabilities in a high-risk zone Bellavista, in the district of La Esperanza, outside of Trujillo, Peru. The majority of program participants have conditions such as Cerebral Palsy, Down Syndrome, mental retardation, developmental delays, and autism. This area has varying degrees of geographic isolation from healthcare/public transportation, and in some cases limited comforts such as electricity or water, in addition to high rates of crime, and problems related to malnutrition and infectious/parasitic disease.

police patrolling Bellavista on horseback

 It doesnt take much time for a gringa up in Bellavista to expand the borders of their comfort zone! The obvious socioeconomic disparities are in your face - sanitation/hygeine issues, babies crawling around dirt floors with animals, some homes covered with only tarps or peices of scrap metal nailed together. The mountainside-combined-with-desert terrain makes it difficult to form any sort of sustained agricultural effort, although one of CMMB's projects has included some hardy plants that require little water. Unfortunately the area is notorious for all sorts of crime.

homes in the upper part of Bellavista

However, I fell in love with this community when I lived in Perú- perched up on a hill, with sweeping views of Trujillo and even out to the ocean on a clear day, the calm "quiet" of roosters and children playing without the usual obnoxious car symphony (only because in the upper areas, cars cant handle the terrain- or drivers refuse to go there, because of it's reputation), getting chased by wild dogs, seeing police patrolling the neighborhood on horses, feeling rugged traipsing around through deep mounds of sand that make any walk a workout. Best of all, the community, true to Peruvian culture, is one of beautiful hospitality and family values.

Perú in general does not excel in forms of support for persons with disabilities, and the caregivers of these children fight day in and out to meet the basic needs of their families. Rehabilitación con Esperanza is based around a system of local healthcare volunteers (speech therapists, physical and occupational therapists, psychologists, etc). who conduct home visits with children and their caregivers, in addition to utilizing community agents and educational components in the program to improve the quality of life for the children and their families, an integral part of the design.

Monica Sanchez, the projects' full time PT

The project recently gained the support of a full time physical therapist, Monica Sanchez, who is doing absolutely incredible work with the kids. We were fortunate to get a glimpse into the inner workings of the project by joining the local volunteers for home visits. The Regis students did a great job coming up with games and exercises based on what resources were available in the home environments. We also had a workshop with the team of volunteers to collaborate ideas for topics such as balance strategies/fall prevention, and included the 2nd annual pool party on our last day with the kids and their families.

Regis DPT students get creative with home visits

Not only was it rewarding to see how this project has grown,  but it was also wonderful to see how certain individual children in the project had improved since we visited last year. I am thrilled to see Monica on board, an amazing person who gives up a higher paying job to climb up the sand hills in the heat every day, putting her own safety on the line and tirelessly providing quality home care to these kids - while also getting the families involved too! And, as I mentioned in a prior post, local students from the PT school will now be assisting with home visits as part of one of their courses, due to a formal agreement that was signed in August with ALAS Peruanas, which is another huge step from where we were last year.

Regis-CMMB Annual pool party!

This community based rehab model is being considered in the inclusion of other projects to (hopefully) begin in other parts of Perú in 2014! I can't commend CMMB and the local volunteers enough for all that they are doing to enrich the lives of so many in this community! MUCHISIMAS GRACIAS for all your hard work and hospitality!

CMMB "Rehab. con Esperanza" volunteers and Regis students teamed up for one week

Third Annual Conference!

2013 Conference leaders: Melanie Mae, Emily Redd, Ana Herrera and Nancy Mulligan

 On August 10-11, 2013, CMMB partnering with Regis University put on the 3rd annual rehabilitation continuing education event in Trujillo, Peru ("Tercera Conferencia de Actualización en Rehabilitación: Avances en Terapia de Lenguaje y Lumbalgia").

Ana Herrera

Similar to past years, we included a format of both lectures and labs/hands-on practice, provided resources for documentation/home exercises, included a social networking luncheon, and utilized actual patients in practice sessions. 

Melanie Mae with translator David Mercedes

Emily Redd

We were fortunate to expand our scope this year to include a track specific to speech therapy, led by Emily Redd and Melanie Mae, who did an awesome job!

Nancy Mulligan demonstrates a lumbar manipulation

Regis DPT students assisted with the labs in the group focusing on low back pain, led by Peruvian Ana Herrera and Regis faculty Nancy Mulligan.  The low back pain group focused on teaching the classification-based approach to patient management, and it was exciting to see an engaged group willing to practice hands on techniques with manual therapy, directional preference exercises, and core stabilization.

Lab Session with low back pain group

We continue to learn more and more each year and have decided to modify the model for the future. While continuing education is extremely valuable and needed in northern Peru, we hope to plan an event with the local PT school, Univ. ALAS Peruanas, focusing more on the training/collaboration with local faculty in efforts to build on sustainability and widen the collaboration/spread of knowledge in the years to come.

the always eventful transportation of "colchonetas" for labs :)

networking luncheon

A special thanks to CMMB and Regis for the continued support, especially Claudia Llantén, Heather Platter, Nancy Mulligan, Ana Herrera, Emily Redd, Melanie Mae, Megan Haas, Rachel Neiman, Danielle Dominguez, Shekema McCarthy, Leslie Padget, and Ruchi Bagrodia! Y Muchisimas Gracias a Maria Roldan, David Mercedes, Cristina Barrientos, Fernando Arana Rios y Maria Ysabel Lopez por TODO!

volunteer appreciation dinner

A Triangular Team, and a TV interview!

Regis and ALAS Peruanas students collaborate

One of the largest goals in our 2013 trip was to build the relationship between Regis University's DPT program, CMMB, and the local PT school "Universidad ALAS Peruanas." The last few years we've had short meetings in the itinerary, but this year we were thrilled to see the relationships really take off! Regis students spent a few days with the ALAS students working together in clinic and in the community doing home visits. We spent an afternoon teaching and learning from eachother on campus, partnered up local students with Regis students, and even had a social dinner and night out dancing at El Estribo!

This year we made things "official" with a formal partnership contract signed between Regis and the local school. On top of that, ALAS signed an agreement with CMMB committing their PT students (who are in a community based rehabilitation course offered once a year) to spend a semester volunteering to conduct home visits for CMMB's public health project "Rehabilitacion con Esperanza!" I was beyond excited to see the effects of this triangular team, and to know that the kids/families and CMMB will be receiving more local resources. And we discussed ways to strengthen the relationship throughout the year, via ideas like online learning/curriculum sharing, faculty conferences and campus teleconferences highlighting patient case studies.

Who would've thought that one little conversation with one doctor 3 years ago would snowball into where we are today?! I hope we only continue to build on these bridges in years to come!

Part of being friends with the university director means that you also get roped into other activities... like speaking live on national TV on a very short notice (and in a foreign language!!!) Never thought my first TV interview would be in Spanish, but I survived, haha! (My family and friends who saw it said that they understood me perfectly.. I think they were just being nice!)

TV interview with Yesenia Salinas, director of ALAS Peruanas

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