Thursday, March 11, 2010

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.


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