Outpatient Rehab

The first few weeks of work have been a blur! It’s hard to get started as a PT working by yourself- all initial evaluations in the beginning to build up a caseload! (Not to mention, all initial evals in a foreign language, with limited resources!) I’ve put together some documents translated in Spanish- initial eval forms, patient history, versions of functional outcome tools, home exercise plans, etc. to hopefully increase the quality of care and serve as resources for other PT’s here.


For the most part, I haven’t seen anything too crazy in the outpatient clinic. My typical patient is a 30 or 40-something year old mother with low back pain. I’ve also seen a fair share of shoulders, knees and necks. Last week, however, I made my first referral- I had a patient show up at the door doubled over in severe pain, with bilateral pitting edema and a large, hard, pulsating abdominal mass. YIKES! They would not take her into the emergency room until her family had waited in line to pay the cashier in advance.


Some of the biggest challenges so far in the outpatient clinic have been…


1) “Peruvian time.”
Peruana Cosita Importante #6 – “Peruvian time” dictates that late is on time here, and it’s not uncommon to wait several hours for people to show up for meetings, outings, etc. The slower pace is nice in some ways, but can also be frustrating and can completely alter the course of your day.


I’ve tried to keep a schedule with patients but they tend to show up whenever they can or desire. The trend is that the first hour of work, the room is empty, and then everyone shows up at the exact same time- typically 3 or 4 patients ready for treatment while I’m not only in the middle of an eval, but have two other new patient evals waiting! Add a little chaotic arguing about who was there first and… It can get a little overwhelming, especially with the small physical space in the PT room and the fact that there’s no-one else there to help.

2) Lack of patient adherence - this affects home exercise programs, (lack of) lifestyle changes, patient progress and follow-up visits too. Most often the reasons appear to be economic/financial, and of course cultural. Many of my patients are illiterate which poses additional challenges.


3) Expectations about PT – because of previous experiences, many patients express that they expect a passive treatment filled with heat, ultrasound, ESTIM, infrared, and massage for every session. The concepts of regular physical activity and exercises seem relatively foreign within the population.


4) When to say no - As a new volunteer here, I’m constantly bombarded with- oh, can you take a look at me for free? Or, my _______ (insert friend, relative here) has a really bad _______. For my friends from school, this is something we get all the time, right?! But, it’s harder to say no when it’s someone in my host family or the other healthcare professionals I work with… the person who helped me when I was sick, the person who fed me an incredible meal… With the hospitality level so high here, I feel like people are offended when I don’t jump right in to examine them when I’m off-duty. And when it’s one of the nurses I work with saying, “There’s this little boy who can’t walk and his family is simply too poor to pay the 5 soles for therapy...” Where would YOU decide to draw the line?