Signing off...

Sorry for the delay on this post and to those of you who have been awaiting its arrival. Yesterday was a busy day and we were up for an early departure this morning so time and internet for completing the blog has been limited. Right now we are sitting in the Miami airport and headed home but I will give you a brief run down of our last day in Guatemala.

Wednesday was our last day to spend at the Las Obras and in Guatemala. We spent the morning treating patients and finishing up presentations. Following the presentations we said goodbye and thank you to all of the therapists at the hospital for allowing us to spend so much time there. They had prepared a special Guatemalan “snack” to thank us for our time and energy and we were super honored and appreciative.

To wrap up our time at the hospital we arranged to take a few of the patients out for ice cream! After lunch we all met back at the hospital, grabbed our patients and headed out to the park. We had quite a diverse group of patients ranging from ages 6 to 82 all in wheelchairs. Each of us truly learned the difficulty of maneuvering a wheelchair over curbs and cobblestone and I am sure we all have a new found appreciation for accessible ramps, streets and sidewalks. The patients seemed to really enjoy the outing and it was great for us to just spend time with them as friends and not just as therapists.

Rain cut the ice cream outing short but before we headed back to the hospital a very nice Guatemalan restaurant owner unexpectedly approached the group. He said that he had seen what we were doing and was impressed that we would give that time to his country. He invited us to dinner at his restaurant in an effort to express his gratitude and “give us a gift.” We were truly honored by this invite and were able to spend one last wonderful meal in Guatemala together as a group.

Our last day in Antigua was one of mixed emotions. As much as we are excited to get back home to our friends and families, the time here has been one that has touched all of our hearts and it was difficult for us to say goodbye. Our adventures in Guatemala will surely stay with us forever. I know I speak for all of us in saying that this experience has helped us to grow as students, faculty and clinicians. We hope that this trip will continue to blossom and that our relationship with all of those we have encountered here will continue to grow for years to come.

In a final note, we truly appreciate all of the love and support that all of our friends and family have given throughout this journey. We most certainly would not have been able to accomplish and experience all that we were able to without your help. Thank you so much!

This is the entire UNC Guatemalan crew signing off for now…until next year!!

Sustainable Service

Yesterday’s presentation on aquatic therapy kicked off a series of educational programming for the Guatemalan health care professionals. Today, several members of our group presented evidence-based lectures on various topics including management of low back pain and pediatric handling techniques. These presentations included a laboratory component in addition to the didactic portion. Numerous Guatemalan physical therapists, physical therapy students, physicians, nurses and support staff attended. All of the sessions were well received by all of those present with interactive discussions and demonstrations.

The educational sessions presented this week are designed to foster change that lasts beyond our service time here in Guatemala. Our hope is that we create sustainable change in the way Guatemalan therapists practice and the way patients are managed and treated. Physical therapy is a lifelong profession that requires constant learning and adaptation of one’s skill set. This is accepted as standard practice in the United States; however, is less common in developing nations such as Guatemala. Therefore, we are extremely grateful for this experience and the opportunity to instill the value of continuing education in Guatemala.

Over the course of the last week, collaborative learning has been ongoing. Our team has learned just as much as we have shared, if not more. Collectively, we have all grown culturally, professionally and personally. This experience, will no doubt, change the way we practice. Our perceptions have been challenged and we have heightened our awareness of cultural diversity. In addition, daily, we are testing the boundaries of our previous knowledge and experience.

Thanks again for following our trip!

Education Continues

One of our main objectives here in Guatemala was to teach the therapists ways to make the children more functional in ways that would carry over to long term.

In America, these tasks would be accomplished over a period of months to years with the help of the child's parents. Obviously, within one-week’s time, we are not able to make much of a difference in these children’s lives. In order to attempt to make a lasting change, we wanted to offer the therapists in Guatemala continuing education that could serve to benefit their patients.

In America, physical therapists are required to attend a certain amount of continuing education each year in order to maintain their license. However, in Guatemala, no such regulations exist and many therapists are relying on therapy interventions that are no longer up to date with current literature.

Therefore, a main goal was to educate the therapists so that they would have the tools necessary to carry over therapy activities into everyday function after the education that we offered them. Three of our students and one of our professors planned different continuing education seminars during our time here in Antigua, Guatemala.

Today, Courtney began our continuing education with an aquatics lab. We were amazed at how receptive the Guatemalan therapists were in trying new forms of therapy.

Below are pictures from Courtney’s aquatic lab with patients from Las Obras. Courtney was able to give one-on-one instructions to each therapist and child.

After the children left the pool, Courtney held an instructional tutorial just for the therapists. Here they were able to ask questions and try the different movements on our volunteers.

Following the pool time, Courtney gave a presentation on why these techniques work and how they should be used. Comments from the Guatemalan therapists confirmed that we were giving them useful information.

One Guatemalan therapist said, “I’ve never seen this before, and I’ve also never seen this child so relaxed.”

With the spasticity and contractures that often complicate functional activities for a child with cerebral palsy, water is a great means to introduce new activities and new sensations while working on functional impairments. When incorporated into therapy, current research demonstrates that the information Courtney presented can carry over into improvements in these children’s functional activities. Most of all, these activities are new and FUN for the children that live at Las Obras.

Therapy in Guatemala

This past weekend, some of us went to a Jade workshop at a local Guatemalan's house. His name was Francisco and after the 6 hours that we spent at his house, he told us that "the next time we come to Guatemala, his house was our house." He allowed us to pick a piece of raw Jade that he cut from blocks of Jade that he, himself, carried down mountainsides. He then taught us the next seven or eight steps to create a piece of jewelry. These included molding, 6 different sanding belts, and polishing. Those who attended now have a much greater appreciation for jewelry. As we were taking pictures for our own personal collection, Francisco asked if we could take pictures of him and his family, as those would be the only pictures that the family had. Obviously, we were honored, and we will be printing out some pictures and delivering them to his house before we leave.

Below is a picture of a raw piece of Jade and the resultant product. Francisco tried his hardest to not help any of us throughout the process, since the Jade "nos respresenta." (Or- the Jade represents us.)

Below is a picture from our entire group after we ate a delicious breakfast on the way to Lake Atitlan.

Celebration Sunday

Today is both Guatemalan Labor Day and Bevin's birthday, so we all decided to head out for another adventure with Hugo to celebrate!

We started the day by making our own tortillas at breakfast. While it seems like it should be easy, ours were definitely not up to par with the women who make over 50 lbs of tortillas a day. Can you pick out which ones were ours?

After breakfast we went to the Iximche Mayan ruins to experience a little Guatemalan history. While we were there we were even lucky enough to witness some traditional ceremonies asking for blessings and safety for their families.

Next stop was an overlook for Lake Atitlan, which was formed in the crater of a volcano after an eruption thousands of years ago. There are now 18 villages that surround the lake and lots of beautiful scenery to go along with it.

We got the amazing opportunity to zipline through the area surrounding the lake over a series of 8 ziplines. We got a few last minute instructions and then away we went! Everyone was all smiles by the time we got back down.

We even saw a couple of monkeys along the way.

Finally we went for a boat ride on Lake Atitlan. We were promised a swim in hot springs along the way, but after jumping in we found that "hot" was a bit of an exaggeration. In fact, it was quite chilly, with a few warm pockets here and there. Apparently the lake the was about 10 feet higher than normal, leaving the warm pockets heated by the volcano too far down for us to feel. But we had fun regardless.

It was a great weekend, but we're back to work at the hospital tomorrow and several of our students will be giving presentations to the Guatemalan therapists this week!

Saturday Adventures.....

Today, part of the group’s day started very early. Nine of us were picked up at 5am to participate in a sunrise hike to the volcano, Pacaya. Interestingly enough our group was able to take a different route than the previous year’s group, due to the volcano’s largest eruption in recorded history last year. The other side of the volcano is now inaccessible and new routes were created to continue the adventures. Amazingly, the areas affected by the volcanic eruption are returning to their previous beauty, with little evidence of the previous year’s events. The group was able to learn a very interesting history of the volcanos in the area from our amazing guide, Hugo. On our hike we were able to make our own coffee and toast our own bread on lava rocks, which were heated from lava flowing from beneath. After a rather steep hike, we were able to see an amazing view of the surrounding areas and the volcanos. Instead of returning down the mountain the way we came, Hugo told us we were going to “lava ski” down the mountain. Quite literally, descending the volcano was like skiing moguls. The rest of the group participated in many activities including jewelry making with jade and village exploration. The afternoon was spent relaxing and exploring Antigua further. For dinner, part of the group visited Santo Domingo, which is a hotel/restaurant converted from a monastery. The group enjoyed a 5-star meal, with the option for an 8-course dinner for less than $40! Today was another amazing day in a completely different way. The group is looking forward to our adventures tomorrow at Lake Atitlan before returning to the hospital on Monday morning.

Group shot with Pacaya in the background

"Lobo", our friend for the hike. Hugo told us Lobo is one of many dogs who"belong to the volcano". They are able to sense an impending eruption and signal for danger. Therefore, if Lobo starts running down the volcano, you start running down the volcano.

Our "oven" to toast bread: rocks heated by lava.

The group "skiing" on lava ash down the side of the volcano.

Our seats for the drive up and down the volcano. Interestingly enough, there were plenty of seats available on the inside of the truck!

One of the entrees at Santo Domingo! Muy bueno!!

PT Across Settings and Countries

Today was another day full of new experiences and adventures. Our group broke off into several smaller groups and each experienced different aspects of patient care. We worked in multiple areas of the hospital: outpatient, the nursery, young adults, and older adults. We worked with the Guatemalan therapists to problem-solve seating problems with the wheelchairs, possible splinting ideas, and methods of handling. While several people in our group are proficient in Spanish, others are not and were forced to learn other ways to communicate for successful treatment and education!

A few stories from the day:

Three of our group worked in the nursery. During the first hour of treatment, communication consisted of gestures and very broken Spanish. Later in the morning, the group met a French nurse that spoke Spanish and a little English. Well, someone in our group spoke French. Thus, through the three languages, we were able to communicate with the therapist about important activities for the success of the child. The child left an impression on the students that worked with him this morning. He was two years old, but his appearance and motor skills were similar to an 8-month old. His impairments were completely due to malnutrition, leading to development delay. That this patient’s impairments were the result of something we take for granted, nutrition, was astonishing. His story will stay with us all.

Several members of our group spent the morning with the adult men's unit of the hospital. The adult men's unit has been celebrating their founding this week. This morning, local volunteers and four of our students took thirty men from the “hogar de hombres” (men’s unit) on an outing to the park. Due to the number of patients, the severity of their impairments, and the cobblestone streets, this outing proved very tricky! The streets and sidewalks present inaccessible conditions from our perspective. However, the people are resourceful and make it work. The patients were able to enjoy the pretty day in the park and eat a yummy snack.

Other members of our group had the opportunity to go to a new community medical clinic just outside Antigua. This clinic was built through the Houses to Homes organization, entirely by donation. The clinic is modern and kept immaculately clean and organized. It opened about 10 days ago and is still setting up everything and assessing the needs of the community. The staff consists of a general practitioner, pediatrician, and nurses. Two needs have already emerged since the clinic’s recent opening: developmental care and musculoskeletal evaluation and intervention. Fortunately, these are two areas in which physical therapy can play a large role! The group that attended the clinic today laid the foundation for continuing education opportunities during future trips. The group explained physical therapy’s role in the evaluation and treatment of specific conditions and will return next week to provide education on evidence-based interventions for patients with low back pain. They will also follow up with several pediatric patients treated today.

Overall, we had a full day that allowed us to see physical therapy played out in multiple settings. We found ways to communicate, to treat complex conditions with few materials, and had a lot of fun.

To end, here is a picture of the 7 students on the trip, enjoying a stroll through the main square.

Thanks for following our trip!