Saturday, March 13, 2010

Put a little boogy in it

Yesterday was our last day at the clinic and our last official day in Guatemala. We said our "see you later's" to the staff and patient (as many have expressed an intent to return as official PTs),

received our volunteer diplomas,

and met this guy.

It was amazing and we are so grateful to have had the opportunity. Thank you for reading - and specifically, thank you... the Division of Physical Therapy at the University of North Carolina at Chapel Hill: for encouraging our learning in a multitude of ways... our Alumni: your financial support is a testament to your belief in education and your joy in the art and science of physical therapy... our family and friends: who have walked with us in our journey to Guatemala and towards becoming physical therapists...

Your support has made this past week possible and we appreciate the opportunity to be able to represent each of you here in Antigua!

Thursday, March 11, 2010


When many hands make light work, everyone finishes early. When that happens in Guatemala, amigos get together for futbol.

A short walk through Santa Maria de Jesus, up ever escalating cobbled streets, is quiet and expectant after a long day of work. Stray dogs, little children, men on horseback and women in traditional dress are all moving through the streets, casting glances at our small and unfamiliar procession. Finally we arrive -- a right turn onto a dirt path that leads out onto level earth high above the city. Our field is a concrete court equipped with basketball hoops and the frames of soccer goals. Teams are chosen and the ball is quickly put into play. We have four players on each team in a game where, without nets, the ball must touch one of the posts.

Exhaustion is universal, but so is enthusiasm, and the adventure of forging new friendships. We run, we pass, we wrestle, we injure, we score, we run some more, we pant, we sweat, we play on. Often, we lose the ball. It rolls down the steep slopes of this volcanic terrain. Occasionally, the two boys playing on the court below us return the ball to us--shyly, proudly. But often, we chase after it ourselves. The lucky ones who are left on the court have a moment's pause. And in these moments, we slowly collect fans. Two little boys scaling the fence. One and then another and then another leaning into the side of the hill. Squinting, they multiply. Until seis, until we are all panting and soaked through with sweat and a hundred children appear from the path, wanting their chance on the field. We all sit together for a while, drinking water and resting - finally - after the long day. In the truck ride home, Fernando, one of our teammates gives his friendship bracelet to our teammate. So you will remember me, he says in Spanish. This connection, another goal scored.

Can you dig it?

Whistle while you work

So this was the crew for Thursday with From Houses to Homes - we were able to work at one location, two sites, to build the foundation of what will become two homes, each of which will house 8 individuals. Given that this was our second day interacting with the FHTH crew, we were all beginning to become comfortable with one another, working together, eating together, and even playing together (a more detailed post on the latter coming soon).

“Ice-cream is exquisite. What a pity it isn't illegal.” Voltaire

I scream, you scream, we all scream...

(literally...and over and over again) for ice cream! :)

Wednesday afternoon was a sight to see...and what a beautiful one it was...

At Las Obras, you are able to gain permission to take patients out into the community for a paseo (or a stroll). We received permission to take 7 young adults and 4 children for ice cream...and we had a delicious time watching their happy faces enjoy this small pleasure of an afternoon stroll and a treat.

But we also experienced inaccessibility...and the difficult in manuevering Antigua. Antigua means "old" :) and by this reference, you can deduce that the roads and architecture mimic the customs of long ago, likely when ADA did not exist. Roads are consequently entirely of cobblestone, and given their age, the government has preserved them (and rightly so, they are charming and historic). For those of us with sound body (and for some of us, of mind as well), these roads do not present an insurmountable challenge...however, for the patients at Las Obras who are in wheelchairs, they present an impossible barrier - how do you connect with your community if you are not able to access it independently?

Many of these patients, particularly the young adults, are independent with their mobility within Las Obras. But outside of the complex, they become completely dependent on others to manuever their environment. For us, it was a particularly enriching experience to share with them. We had difficulties ourselves manuevering the wheelchairs, not only on the cobblestones, but also on the curbs as many did not have ramps. Yet, we all did it...we worked hard and they cheered loudly...sweat dripped off our foreheads and ice cream dribbled off their chins...smiles graced every face. It was a very sweet afternoon indeed.

A day in the life of a Guatemalan PT

Life as a Guatemalan physical therapist at Las Obras is in many ways very typical - evaluate and treat patients with goals aiming to improve functional living, use of equipment (such as standers, walkers, exercise bicycles, toys, mat tables, cold and hot packs, etc), and the development of provider-client relationships...and the pictures below will attest to those similarities.

But the differences are what is most striking. Las Obras employs 3 physical therapists, one in each area: children, young adults, and elderly. Each therapist attends a university for 6.5 years and often find scholarships from announcements on the radio, newspaper, and television. Each area also had several others working in a similar role as a physical therapist assistant. However, each therapist and assistant are also responsible for approximately 30-35 individuals, most with a very severe form of cerebral palsy.

Many of the patients at Las Obras are abandonment cases, both young and old. Families will leave a member with a disability abandoned on the steps of the local churches. Because little to no information is available, many of the patients have names based on the church that they were found in front of, such as Mercedes for a woman found in front of the Merced church. Additionally, given that the government has not prioritized health care, many of these individuals have not received medical attention until they arrive at Las Obras. As a result, many display severe spasticity or stiffness throughout their joints, lack muscle coordination to control their movements, and have difficulty walking (sometimes walking on their toes, in a crouched position, or with a scissored leg pattern). Although cerebral palsy does not have a cure, if it is properly managed from its onset, many of these individuals can enjoy near-normal lives. That is not the case at Las Obras - because of the circumstances in which these patients arrive at Las Obras, often the only option available for the physical therapists is to maintain function...and one factor that is different for these patients is that they ALL receive physical therapy, even if it is only to maintain.

But there are many barriers here to providing physical therapy. There are too few therapists and too many patients. Resources are very limited - they are working with whatever is available. In accordance with this, therapists have difficulty maintaining body mechanics given that they do not have mechanical hoyer lift tables or adjustable standers (e.g., the tables or standers that are automated to lift/lower to the appropriate height).

In short, we have been seeing the progression of a disease like cerebral palsy that is left untreated - patients with multiple contractures (extremely shortened joints, it would feel kind of like trying to pull apart a very long wrench that has been krazy-glued it sort of gives but not really...making sense?) For students, it has been an incredible opportunity to feel what the textbooks describe and classmates try to mimic. For the faculty, it has been amazing to see the growth of the students as they embrace this learning experience.


Wednesday, March 10, 2010

Santa Maria de Jesus: A family

This is one of the families that received concrete flooring from our Houses to Home project on Tuesday. They are standing in what is the patio but it essential serves multiple purposes, including: laundry area, bathroom, shower, and kitchen. The mother was a widow with 12 remaining children (there were 15 but 3 had passed away). Of the remaining 12, 4 were married and lived doing the math, 9 people lived in the home. You'll note that the women and daughters wore typical Mayan clothing, whereas many of the young boys had more modern clothing, such as Gap.

An interesting thing happened as we were nearing the end of our project - many of the women and children came over to inspect the finished product. It was novel and thus, a very big deal.

And one last picture - this is Hector, the youngest child. He, of his own volition, wanted to be involved with the cement process. So he took it upon himself to move the empty buckets back to the start of the line to be refilled with the cement. As the day progressed, his fatigue became evident, but he persisted, and even muscled two buckets at a time several times.

Let's get physical

De Casas A Hogares (From Houses to Homes) has a mission: to construct a future for Guatemalan families and communities "by building lasting, healthy homes, improving access to health care and education, and inspiring participation between the poor and civil society." And to date, they are on track for doing so, having already:
  • Constructed 300 new homes providing housing for 1,780 people;
  • Repaired an additional sixteen homes, making them liveable and providing housing for 72 people;
  • Provided safe and efficient stoves for 35 families;
  • Provided school supplies for 96 students in 2009 - but cumulative, have helped to educate a total of 1,001 children by paying for their registration and/or school supplies.
On Tuesday we joined From Houses to Homes to join them in their efforts. We arrived to their headquarters, a gang of disheveled and slightly rowdy work horses. We split up by casitas (or our houses) into the back of two pickup yes, if you're thinking, "Does that mean they were in the back of the truck?" you are correct...that's how the Guatemalans do it, that's how we do it :)

We drove about ~25 minutes, a beautiful winding road uphill, the wind blowing gently, the city becoming smaller...the vista laid out before us in all its splendor (seriously, think "Gone with the Wind" it was that green and lush....but much more savage in its application). We arrived to Santa Maria de Jesus, a decidedly different community than Antigua...and vastly contradictory from what one might expected given the drive. Santa Maria is more typical in its poverty, seen in its provisional houses made of corrugated metal siding, scraps of wood, and plastic bags as siding. The floors are made of dirt and most have leaky roofs.

Families are often selected by community vote, where the village will nominate the family they think is most deserving. From Houses to Homes then visits the family over several months to see how they are actually living. The only requirement to receive a home is to be very poor and to prove ownership of the property.

Today, our two groups went to two different sites to pour concrete floors. The process is quite different here as you are likely already imagining:

Step 1: Bring all of your own supplies: shovels, buckets, rocks, cement mix, food, toilet know, the essentials :)
Step 2: Even out the dirt floors by hauling out in buckets
Step 3: Move sands, cement, and rocks into one big pile
Step 4: Move said pile into two piles
Step 5: Move said two piles into one pile again (time consuming but you could definitely see the utility in this method when you do not have a mixer)
Step 6: Add water
Step 7: The assembly line begins: we had mixers, carriers, and smoothers...all technical terms of course
Step 8: Step back and admire - concrete floors completed.

In summary:
40 wheelbarrows of sand + 20 bags of cement + 10 wheelbarrows of rocks + as much water as needed + 4 Guatemalans + 15 even more disheveled gringos = 2 homes with flooring (4 floors in total) and many achy body parts...but ah! the memories :)

And really, being this physical with shovels and buckets of cement can be akin to being a PT...think about it...

Tuesday, March 9, 2010

Real or fake?

After our introduction to G-time, we ventured outside to explore the neighborhood surrounding Las Obras. These sights (both human and non) surrounded the hospital...given the early hour, we were not able to go inside yet, so we have limited information on the significance of these structures. But we hope to explore these more fully during a lunch break later this week and will hopefully have more details to share then...

...also, you'll note the puff of white smoke coming out of a volcano situated behind the of our members, who shall remain nameless :) saw this and due to the awe of its sheer mystique, its exquisite formation, and its stillness, exclaimed, "It is for real or for fake?" So you tell us - is it real or fake?

And if you've been reading this blog, perhaps you'll think "guat-ever." But regardless, we hope that you have enjoyed reading about our journey here...and we hope that you'll continue to tune in throughout the week...we'll soon be sharing about pouring concrete and building homes...they call us physical therapists, you know? :)


Guatemalan time, or G-time as we have affectionately nicknamed it, is when Guatemalans get to other words, waiting is part of everyday life here, it is part of the culture. Of course, given that "being on time" is a part of the American culture, it was an adjustment. On our first day at Las Obras, we had understood to arrive at 7am. So we did. And upon checking at the receptionist, we were informed that the volunteer coordinator does not arrive until 8 or 830am :)

And thankfully, by this point in the trip, the group had adjusted to G-time and went with it...we all went for a walk turning this way or that way, exploring a different part of Antigua and stumbling upon neat architecture and refueling on coffee. Life is a little slower here...and it's good.

Note: the above "actors" were not paid for their work :)

Sign sign everywhere a sign

So...two brief instances of all that is lost in translation. The first is completely serious and the second is completely comical.

First, is the wheelchair sign that we came across on the sidewalks surrounding Las Obras, located approximately every meter or so. These signs are "place holders" to communicate that these pieces of sidewalks are reserved for individuals that are in wheelchairs. So if a volunteer wants to take a patient out for a sunbathing session, these spots are ready and waiting - although we did not get to see or participate in this event today, it sounds like a lovely idea - a corporate sunbathing session for individuals who may not necessarily be ones that you associate with that idea.

Second, is the Star Wars reference. On our walk home from the clinic, we came across this advertisement which stated, "Lucke, I'm your Father." At least they got the gist of the message...however, it doesn't really correlate to the advertisement that is selling internet, movie, and music eqiupment...maybe we're missing something?