Guatemala - Day 6

Dear Evan and Nathan,
     Today was our last day of seeing patients in Guatemala.  We spent the day at the clinic in Gualan.  We saw 125 patients in 5 days.  That is a lot!  Today felt slower than the rest until we got a 2:00 rush and everyone seemed to need physical therapy.  This week has been an extremely rewarding experience.  It is rewarding as a clinician - we have helped so many people to live with less pain, improve function, and (for children) increase their participation in their family.  And it is rewarding as a teacher - each individual has been treated with a great deal of dignity, compassion, and competence.  These women have shown a passion for serving and for our profession.
     Tomorrow we leave at 5:00 am to drive to Antigua.  We have to leave that early to avoid the traffic from construction over the mountain pass.  That should give us the whole afternoon to explore Antigua.  I think you guys might get tired of walking and seeing the sites, but your dad would love it and I wish he were there to share it with me.  One of the highlights of this trip, though, has been getting to know my students better.  These women are truly a joy to be around and have varied and interesting backgrounds.  I know I will enjoy the last two days with them.
     This week has flown by.  I can't believe it is nearly over.  I miss you bunches and bunches.  I love you above you!
Love, Mom

Dressing a wound

Luis was the first person I met in Guatemala.  He has grown quite a bit since then! 

Our friend in the middle picked this pose for us. 

Alex and J.R., who are to the left of Miriam, are WSU students who worked with us this week.  We were all impressed by their level of maturity and interest in our field.  Our work really had a positive affect on them, too.

Guatemala - Day 5

Dear Evan and Nathan,
     Today was a very full day in Zacapa.  We saw patients in the clinic near the hospital.  We saw a lot of children as well as adults with musculoskeletal injuries and neurologic conditions.  The girls put about everything they have learned up to this point into practice.

    At the end of the day, we visited R.O.M.P., which stands for Range of Motion Project.  They build prostheses for people with amputations.  Even though it is next door to the physical therapy clinic, I have never been inside to see what they do.  What important work!  They have made over 3000 prostheses since opening in 2005.

     I hope you are having a good week.  I enjoyed talking to you for a moment last night.  It's too bad we kept getting cut off.  Be good for your dad.  He is having an exhausting week!

     I love you and miss you tons!

Love, Mom

Coty figuring out the very old electrical current unit for low-rate TENS, which we don't do often in our neck of the woods.

Mercedes - blowing out an AFO

This little had a spinal cord injury from a gun shot wound when he was three years old.  He was so fun to work with.

Guatemala - Day 4

Dear Evan nd Nathan,

     We had another good day.  We started off by spending about 30 minutes visiting Maria's daycare.  Do you remember me telling you about her last year?  She had polio as a child.  Karen, who is the director of H.I.M., took her to the United States for surgeries for her legs.  She lived with Karen for about 18 months, then returned to her family in Teculutan.  Years later, there was a need for daycare in the town.  Many children were not going to school because they were staying home to take care of their younger brothers and sisters while their parents worked.  Maria now runs the daycare.  She has the maximum limit of 12-13 kids.  It is like a pre-school.  The children learn some English.  They learn to recognize and write their letters and numbers.  They get a nutritious breakfast and lunch, which is important because many of them do not get a lot to eat at home.
     Next, we saw patients at the H.I.M. Center for Rehabilitation in Teculutan.  They moved their clinic in September, so this was a new space for me.  It was larger than their old clinic and is in a better location for clients.  We had a full day of patient care and then went back to the hotel to do aquatic rehab with a woman who had multiple fractures and countless subsequent surgeries from an accident.  She cannot walk on land, but we were able to do a lot of exercise in the pool.

     Evan, I hope your baseball practice went well! 

     Nathan, Did you play baseball with Dad during Evan's practice?

     I miss you both very much!

Love, Mom

A 'healed' fracture of the tibia and fibula.

Group photo outside of the panaderia next door to the clinic.  After smelling the bread all afternoon, we had to try it!

Our evening aquatic rehab session

Guatemala - Day 3

Dear Evan and Nathan,

     We had a busy day today.  We evaluated and treated 27 patients at the Quigue Ceron Foundation in Esquipulas.  Quique suffered a spinal cord injury several years ago.  He had previously been a motor cross rider.  There was no rehab in his town so he sold his bikes and built a physical therapy clinic in his home.  He and his mother have done a lot of work for their community.  Along with his foundation, they run the rehab center and recently purchased land to build a new facility.  They also just completed and opened an arts center.  The rehab center is staffed by a physical therapist and is well-equipped and well-utilized by the community.  They are very fortunate to have such a place. 

     Quique was really kind.  He had a full line-up of patients scheduled for us.  He bought us lunch and offered coffee and cookies at the end of the day.  It was really neat to get to see what he has accomplished.

     Esquipulas is up high in the mountains.  It was a beautiful drive through the dry mountains to get there.  It was 100 degrees again in Zacapa, so we were happy to be in the mountains where it was only 92 degrees.  Esquipulas is a lovely town known for its basilica, which is a pilgrimage site.  After we finished seeing patients, we visited the basilica.  It was a beautiful building in a lovely setting.

         I hope you had a good day at school and fun at soccer practice.  I love you to the moon.

  Love, Mom

This flier advertised our visit and encouraged people to make an appointment.

Holding clinic.  We saw 27 patients today.

Examining x-rays

This 18 month old has microencephaly from Zika

Coty hard at work

 Acacia performing ankle mobilizations

 The clinic is also Quique's home.  The courtyard was a beautiful garden.  It was very peaceful and truly contributed to the overall mission of promoting health and wellness for individuals with disabilities.

 After we finished, we met outside for our goodbyes.

We were presented with a certificate of appreciation for the University of Puget Sound for our work in Esquipules.  The girl presenting the certificate is a Guatemalan teenager who is part of the Access Program.  The Access Program is run by the State Department through the American Embassy.  Teenagers are taught English and leadership skills.  It started in Afghanistan and Iraq, and was introduced in Columbia and Central America recently.

 El Catedral Basilica de Esuipulas

Day 2 - Guatemala

Dear Evan and Nathan,

      We spent the day treating patients at a mobile clinic that we set up in Noruega, Zacapa.  As a group, we saw 26 patients.  Most had orthopedic complaints, but our team also did a terrific job of identifying patients that were not appropriate for physical therapy who needed to be evaluated by another healthcare professional.  We identified patients with vision disorders, possible Chiari malformation, diabetes (we had her screened by one of the WSU professors who had the equipment available), and appendicitis (taken to the hospital by our group on our way home).  As one of my students put it, "This is as direct as direct access gets."
     We also got to go on two home visits.  One group went to the home of a young man who was in a motorcycle accident a couple days ago and could not walk to the clinic.  They provided basic wound care for a large road rash.  I took a second group to the home of a man who had two strokes - one affecting his right side and one affecting his left side - who was non-ambulatory and could not sit up by himself, but was well cared for by his family. 
     In the same location, a dentist treated patients and a group of students and a professor from WSU screened families for iron deficiency.  If a family member has an iron deficiency, they are given an iron fish to put in their cooking water.  It gives the entire family the iron supplementation it needs for fie years.  This is very important.  Another team is doing lip cleft and palate surgeries.  They screened 100 people on Saturday.  The first three children they screened were not candidates for the life-saving surgery because they had an iron deficiency.
     All of this was done in 100 degree heat.  I am so proud of my students, who worked with such competence and compassion.
     Dad said you went to the batting cages and also did some fielding today.  Sounds like a lot of fun!     
     I miss you so much! 

Love, Mom

This is our clinic in Noruega.  The group on the right is doing the Iron Fish screening.  Our little clinic is on the left.

 

A clos-up of our clinic.

 

Coty and Mercedes teaching a patient how to perform pelvic neutral.  The woman they are treating came in with small ulcers on her feet.  Concerned about the cause of these ulcers, they screened her sensation, looked for trophic changes (skin), and took her blood pressure.  They suspected she had diabetes so we asked one of the professors for the Iron Fish program to screen her.  Thanks to their intervention, she got the education she needed and will hopefully follow-up with a physician in Zacapa.

Our team at the end of the day, just outside the home of one of the gentlemen we visited.  On the left is Yasmin, a Guatemalan-trained PT that worked with us.  Third from the right is Nancy, a PT who is the director of therapy services for Hearts in Motion.

Guatemala - Day 1

An open letter to Evan and Nathan -

Dear Evan and Nathan,

     We've arrived!  After a long night of travel, our 2018 Global Health Perspectives group arrived in Guatemala City.  Then we took a warm 3 1/2 hour drive to our hotel in Rio Hondo, Zacapa.  We went for a well-deserved swim and relaxed until dinner.  I'm pretty sure we will all be asleep very early tonight.  We have a big day of work ahead of us tomorrow.

     Dad told me that you both did well in your soccer games.  I'm sorry I didn't get to see them.  I miss you! 

Love, Mom

At the Guatemala City airport.  From left to right: Wil, Mercedes, Acacia, Coty, Miriam, me, Adriana

Cooling off in the pool.  Tomorrow it is supposed to be 100 degrees!