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Skillful Hands, Caring Hearts

by Laurie Callahan

“My stomach dropped when I saw some of the patients that I was to evaluate, their bodies locked in unnatural positions, painfully contorted and twisted. …Then something incredible happened. Slowly but steadily, my education began to kick in.”

This is how Marymount Doctor of Physical Therapy candidate Garrett Hurd remembers his first encounter with residents of the Manos Abiertos orphanage in Costa Rica. It was February 2011, and Garrett and 24 other third-year D.P.T. students had traveled to the Central American country for two weeks as part of their Clinical Practicum II course. Though they went there to help others, the experience ultimately had as big an impact on the Marymount students as it did on the lives of the people they served.

To arrange this outreach effort, the University partnered with International Service Learning (ISL), an organization that enlists medical and educational volunteer teams to provide services to people in need around the world. The trip brought the MU graduate students, under the guidance of Associate Professors of Physical Therapy Dr. Diana Venskus and Dr. Jason Craig, to the small city of Alajuela, to work at the Manos Abiertos orphanage, and to the larger city of Cartago, to treat patients at an adult residential-care facility called Corazon Redentor. Both facilities are run by the Missionaries of the Heart of Christ Redeemer. The Marymount group also held public clinics in two local shanty communities or precarios, as they are called.

Preparations for the Costa Rica practicum began well in advance. None of the participating students spoke Spanish, so they all took a Spanish class in the fall. Dr. Venskus notes, “They also completed community-service projects in preparation for this trip as a component of another fall course. For example, they did fitness screenings for a local clinic, then adapted the screening methods for use in Costa Rica.” D.P.T. candidate Katie Kavanagh explains that she and her fellow students also “rotated through a local residential rehabilitation facility that specializes in physical therapy treatment and care of children with profound disabilities. This gave us practice in treating young patients with severe neurological and musculoskeletal disorders.”

Every student had a leadership role in connection with the Costa Rica practicum. Some raised funds and sought donations of medical supplies; others inventoried and packed the supplies and equipment. Once the group arrived in Costa Rica and began their work, some students were assigned to oversee the storage and administration of over-the-counter medications, while others served as on-site evaluation coordinators.

The impressive list of donated supplies for the trip included braces and supports, wheelchairs, crutches, pulleys, traction devices, walkers, splints, ultrasound units, and a neuromuscular stimulator. Inova Springfield Physical Therapy Center; Elite Physical Therapy in Washington, DC; and Dominion Medical Equipment of Chantilly, Virginia, generously donated the majority of the supplies, which were shipped in advance and expected to arrive at the same time as the volunteers. Unfortunately, the supplies didn’t arrive at their destination until right before the practicum ended; as a result, resourcefulness and thinking outside the box were daily requirements during the trip.

The Work Begins
Upon arriving in Costa Rica, the Marymount group took one day to get acclimated and organized. Then, on February 21, they began their work. Dr. Craig describes what they found: “The patients’ ability levels ranged from relatively independent and mobile to bed-bound and locked in place with muscle contractures as a result of neurological injuries.”

Yet what immediately struck the MU volunteers was the positive atmosphere. Garrett Hurd says, “Manos Abiertos is an amazing place – a very clean, well-maintained facility – and the love that the Hermanas (Sisters) have for their wards was as clear as the brilliant blue sky we had for the majority of the trip.” Fellow student Katie Brupbacher agrees, adding, “It was obvious that the Sisters thought of every child as one of their own.”

The level of care was eye-opening for student Kerry Hite. She reflects, “I don’t think I knew that it was possible to have as much compassion as the Hermanas show for the residents of these two facilities. During our stay, we discussed the idea of serving these individuals because they are human beings and have a right to the care that we offer, rather than helping them out of pity.”

As the students began working with their fragile patients, apprehension gave way to assurance. Garrett Hurd remembers, “A little voice in my head started making suggestions: a better positioning option, which muscles to strengthen in order to improve mobility, body-mechanics that would help the caregivers prevent injury to themselves.”

Dr. Craig says, “It was a privilege to watch our students in action! The way they presented themselves and patiently worked through language barriers, neurological barriers, and even systems barriers to evaluate the residents was heart-warming.”

By the second day, routines were taking shape. Dr. Craig recalls, “All day long, there was this graceful movement of therapists and patients from room to room. Some of the patients began to show improvement, and our students were excited to see their work making a difference. Lives were being touched on both sides of the equation.”

Thinking Outside the Box
When the shipment of donated supplies failed to turn up day after day – due to a variety of issues from delayed flights to customs problems – the MU volunteers had to find creative solutions to help their patients. “Adaptations had to be made,” says Katie Kavanagh. “We spent a lot of time fixing and adjusting the wheelchairs they had on hand, to improve the fit for specific patients.”

Discovering a room with racks of wheelchair parts at one of the facilities was especially exciting. Student Nicole Taylor recalls, “We did some serious outside-the-box thinking! We assembled a wheelchair with a variety of parts from multiple chairs, made foot rests from foam and duct tape, and devised ways to engage patients in therapy when the desired supplies and equipment were unobtainable.” Katie adds, “Treating these patients in their own environment required us to be creative. One thing we learned is that fancy equipment is not the key to success.”

Working around the language barrier also required creativity. Kerry Hite says, “I did develop my Spanish-speaking skills immensely, but you have to rely on other cues when your command of a language is less than perfect! I learned how to communicate nonverbally and really discovered how to roll with the punches.”

In the Precarios
Working with the residents of Manos Abiertos and Corazon Redentor was only a part of the Marymount group’s educational mission. They also organized a health and wellness event for two poor neighborhoods, or precarios, called El Erizo and Tropica 2.

Garrett explains, “First we traveled door-to-door, doing a basic health screening. If the person was a good candidate to receive more attention, we gave him or her a ticket for the health fair the following day. There, we performed a more in-depth evaluation of injury, range of motion, aerobic capacity, balance, strength, and nutrition.” In addition, the Marymount students asked detailed public-health questions to assist ISL, the sponsoring organization, with data about these underserved communities.

Some residents were initially hesitant to talk with the volunteers, but Dr. Craig had an idea to break the ice: balloon animals! He laughingly recalls, “We made a few and passed them out. Within seconds, the area around us was teeming with little kids! We had a way in; now we could go about our work and reach more people.”

Student Pam Jennings reflects, “It was a privilege to go door-to-door in this community and be invited into strangers’ homes with such a welcoming spirit.”

One young mother, who sat sobbing in her wheelchair at home, had fractured her spine in a fall several months earlier and was in excruciating pain. Dr. Craig points out, “This patient needed spinal-fusion surgery with intensive PT follow-up. But her poverty and the lack of a social safety net made it difficult for her to get the care she needed.” He adds, “My frustration magnified as I thought of the 12 back braces that we had packed and loaded up, which had not yet arrived. Still, we did what we could to help.” The following day, the woman’s husband brought her to the clinic, and the MU caregivers were able to make some adjustments – to both her body and her wheelchair – that provided a measure of pain relief.

At the wellness fair, patients progressed from intake to musculoskeletal evaluation and cardio screening. The exercise station was the last stop; here, the major findings were brought together in a personalized exercise/treatment program for each patient. For D.P.T. candidate Nicole Taylor, working in the precarios provided the greatest sense of accomplishment. She says, “People came to us with complaints of pain and impaired function and left with knowledge and tools to combat their problems.”

Dr. Craig remembers, “One lady wanted us to look at her teeth! We explained that teeth were outside our realm of expertise. However, I think there were a few in the group who were ready to give anything a go by mid-morning.”

He adds, “Our students felt a deep desire to do everything in their power to help these patients. Each person was treated with tenderness, with respect, with a smile and a professional touch. Physical therapy is not simply about exercises; it is about touching lives and changing people. Our group was doing that and doing it well.”

Making a Difference
Fortunately, the long-anticipated shipment of supplies finally arrived near the end of the two weeks. Dr. Craig remembers, “The students were like kids in a candy store, opening boxes and stacking equipment, earmarking various pieces for the patients they were treating.” The young mother with the fractured spine was not forgotten. Dr. Craig tried to take her a back brace, but found that she had been admitted to a hospital, presumably for the long-needed surgery.

The group’s last afternoon in Costa Rica was spent at Manos Abiertos and Corazon Redentor, educating the Sisters and staff on the particular needs of each patient. “That was the crowning day for me,” says Garrett Hurd. Kerry Hite agrees, noting, “Everything finally came together. The Hermanas were so interested and responsive to what we were telling them that I felt we were making the difference we had strived for all along.”

Dr. Venskus points out, “As a result of this experience, those two facilities now have an evaluation form, follow-up documentation, and bedside instructional documentation for every resident. A system is in place, and the staff can continue to use it to improve patient care.”

Katie Kavangh elaborates: “The individualized bedside forms contain positioning needs, exercises, stretches, and a turning schedule. We also videotaped the training session, to provide an educational resource for current and future staff members.”

Garrett agrees, noting, “I learned that we really do have the power to make a difference. The skills and knowledge we’ve gained through our studies can play a critical role in virtually any patient setting.”

With a proud smile, Dr. Venskus recalls, “As we prepared to leave, Sister Marlene Rodriguez, the founder of Manos Abiertos and Corazon Redentor and superior of the religious community there, told me that our students had done more in 15 days than any other person or group had done in 15 years to advance physical therapy care for their residents!”

Personal and Professional Transformation
In Costa Rica, the Marymount volunteers were embraced with warmth and gratitude. In just a few short days they became members of the communities they were serving.

Many of the individuals they treated were in fragile health and had only a tenuous grip on life. During the group’s visit, a 10-year-old girl with severe hydrocephalus passed away. The students and their professors were invited to her funeral.

In her blog, Dr. Venskus wrote of that day, “Our presence in this community placed us as participants in the final celebration of her life. Every life is precious and has meaning. This young girl shared love and offered love. Today, we are her family as her soul is lifted to God.” Looking back, she adds, “As we left the funeral Mass, the silence was broken by a Marymount student who commented on the joy he had observed in the celebration of this young girl’s life.”

On their final morning in Costa Rica, the MU group held a fun fair at the church in the Tropical 2 precario where they had staged a clinic earlier in the week. It was a way of thanking the community for welcoming them into their lives. Each child received a Beanie Baby (the stuffed animals were among the shipped supplies), more balloon animals materialized, faces were painted, stickers and stamps were put to creative use, and photos were taken and placed in decorated frames.

“There were smiles, and laughter, and joy,” says Dr. Craig. “We had alleviated some pain – not just physical pain, but social pain. For a few hours these children, whose whole lives are defined by poverty, were kings and queens.”

Kerry Hite reflects, “Watching the children that day, I learned that it is possible to achieve great happiness even in the midst of the most difficult circumstances.”

Dr. Venskus is delighted with the outcomes of the Costa Rica practicum. She says, “The students who took part in this experience now think of themselves as independent practitioners. They are ready to begin their professional lives.”

Kerry adds, “I thoroughly enjoyed being challenged to differentially diagnose patients without any prior information. This experience sparked an interest in direct access and primary care that I didn’t have before.”

Katie Kavanagh says that the trip changed her, as well. She observes, “The patients we had the privilege to work with in Costa Rica helped us more than we helped them. I am so grateful to have had this experience.”

Pam Jennings adds, “This practicum forced me outside of my comfort zone, which helped me to grow as a practitioner. It also opened my eyes to a different way of living and made me realize how blessed I am to have everything that has been provided in my life.”

D.P.T. candidate Amanda Shanks sums it all up: “In Costa Rica, I learned a lot about life and love. The people we interacted with taught me how important it is to continue to share my education and talents with others, to help make their lives a little bit better.”

This practicum abroad was just the beginning! The relationship between Marymount’s Doctor of Physical Therapy program and the residents of Manos Abiertos, Corazon Redentor, and the nearby precarios will continue through service-learning trips in future years.

In addition, this year’s group did such a good job of fund raising that some money is still available for special projects. Katie Kavanagh says, “One initiative we have underway is the fabrication of an orthotic device for a patient who came through the wellness screening in one of the precarios and is in dire need of this equipment. We are happy that we can provide an appliance that will make a real difference in this individual’s life.”