Program in Physical Therapy students Carley Kirsch and Anna, "AJ," Van Alstyne (Class of 2013) recently completed a clinical rotation at Hillside Health Care International in Punta Gorda, Belize.
Hillside Health Care International is a not-for-profit clinic that resides in the most southern and impoverished district of Belize, the Toledo District. The overall vision of the clinic encompasses continuity of patient care through a sustainable program run by local Belizean staff and clinicians. It consists of a collaborative group of medical doctors, pharmacists and physical therapists who work together to provide care to the people living in Punta Gorda and in the surrounding Mayan villages.
Kate Lochhead from the Program in Physical Therapy was kind enough to interview Carley and AJ to find out more about what their experience in Belize was like, how they grew from it and how it changed them as physical therapy students. Read more below!
What inspired you to apply to do the work you did in Belize?
Carly: I went to Punta Gorda through a campus ministry spring break trip my junior year and immediately felt a connection with the people and the culture in the area. I have always known that international pro bono work is something I want to pursue and this month long experience was the perfect way to start.
AJ: I had previously traveled to Belize twice through service trips organized by SLU. The diversity of cultures as well as the limited access to health care especially in the Toledo District made a long lasting impression. As a student interested in a future of international non-profit care or humanitarian missions through the military, the opportunity to be involved with Hillside in the development of continuity of care with regards to rehabilitation in Belize was one I strove toward. I knew I would grow as a young therapist and well-rounded individual not only through the unique challenge of limited access to sustainable resources and numerous cultural barriers, but also through encountering the adversity of the limited knowledge of residents regarding general rehabilitation and prevention of simple injury and disability.
|Carley with other students on clinical rotation and Saint Louis University Program in Physical Therapy professor Carol Beckel.|
What did you "do" while there? What was a typical day like? (Did you have typical days?)
Carly: One of the things I loved about this rotation was that there was no "typical" day. I never knew what to expect and even when there was a plan, it was always changing. There were three main settings that we worked in: outpatient clinic, home health, and on the mobile in Mayan villages. All of these settings provided a completely different experience every day with new patients and new challenges.
AJ: As a student practicing within the first clinical rotation of the newly structured rehab department, there was not one typical day. I worked from dawn through dusk seeing patients in the clinic, villages, or their homes in Punta Gorda, assisting in establishing a formalized documentation system, giving presentations to students/volunteers at Hillside or in the schools, collaborating with the medical, physician assistant, and pharmacy students, and performing many other miscellaneous tasks associated with designing an efficient sustainable rehab program.
How did your time there change you as a PT student? As a person?
Carly: To say that I have changed as a student and more importantly a person as a result of this experience is an understatement. It is very difficult for me to put into words right now exactly how much I have changed. The changes that have happened in just 4 short weeks while at Hillside are something I am continuing to discover daily as I re-acclimate to life back in the states. It sounds very cliché of an international volunteer, but one of the biggest changes I have noticed in my life is striving for simplicity and living in the present. Living in such simple conditions and enjoying the constant presence of my fellow volunteers as well as my patients without the distraction of cell phones, strict schedules, and technology allowed me to realize what is really important in life. Sadly, being a student, it is impossible not to live on a schedule or not use a laptop and I am pretty sure my mom would die if she was not able to call me for four weeks again. However, I have been able to see what is the most important in my life and where my focus needs to be in the next several years.
AJ: It is difficult to find the words to sufficiently describe my experience and how I have changed as a result. Through my interactions, interdisciplinary collaboration, and therapist-patient relationships during my time in Belize, I learned an immense amount regarding my ability to adapt and maintain versatility in my role as a health care provider. Simultaneously, I reflected upon my personal growth and how it will enable me to continue to provide optimal care for future patients as part of a health care team regardless of allocation of resources or geographic location.
|Anna, "AJ," Van Alstyne and other students on clinical rotation.
What is something that you struggled with (culturally, etc.)? How did you overcome it?
Carly: Being thrown into a completely different culture with people who have a completely different mindset about medical care was a giant obstacle for me to overcome. With this came the obvious challenges such as the language barrier, a hidden barrier I was not expecting was the how much the lack of knowledge about rehab and physical therapy would inhibit the patient's compliance to care. When a group of people have been performing tasks the same way for generations, they are not very open to my "American" way of thinking. This was really hard for me to accept and deal with as I continued to strive to provide the best possible care for every patient I saw.
Overcoming this was not easy and very difficult to learn in just one month. The rehab program is very new at Hillside, so educating the population about what rehab does, and that even though we do not distribute Tylenol or vitamins, we can still help you decrease your pain is essential. Explaining to every patient that the exercises we give them are not going to cure their pain overnight, but it will help in the long run, is not exactly what they are looking for. There are no disability benefits or paid time off because you have arthritis and your back hurts, so they want instant pain relief. Not working means that your family doesn't eat. Over the 4 weeks, I was able to begin to understand the demands placed on them by their family and their culture and learned to teach some basic adaptations for common problems that they face.
AJ: Although there were many barriers to break through in such a non-traditional PT setting, the most significant struggle I needed to find peace with was simply my place as a white American PT student amongst the Belizean people. I arrived to the clinic most concerned about whether my intentions of flying to a developing country to offer rehabilitation where it is not currently recognized or well understood as a necessity was appropriate. I constantly attempted to reassure myself that I was not imposing my white American health care ideology in working under the first US trained rehab director in the remote villages of the clinic's encatchement area where therapy was scarcely previously introduced. I found peace upon my return back to the states having experienced gratitude by multiple patients and knowing that the director had done numerous hours of field work assessing the needs of the communities and involving as many people as possible to gain information from before designing a community based rehab program.
Is there one particular person/story/encounter that you feel embodies your time in Belize?
Carly: I have been very surprised that this is the most common question I have gotten since I have been back and I feel like I give a different answer every time. There were so many patients I wish I could fly to the US to get the surgery they needed or extensive rehab in a rehab hospital. One patient in particular always stands out to me and I think his story will stick with me forever. I saw the patient as a home health patient. He is in his mid to late 60's and had a stroke about 5 years ago. He lives in a one room concrete house that is no more than 20 feet by 20 feet. In order to get to his house, you have to use the ramp someone built him years ago out of plywood to cross a small stream, but since it was built, the ramp has begun to decay. There are several holes and the wood is so soft that when you walk on it, it sinks. The patient is in a wheelchair, so he is unable to avoid the holes that have formed on the ramp and is afraid it will fall in on him, so he is stuck in his small house all day with nothing but the meals his daughter brings him, a radio, and a rosary. I was immediately in awe of this man as soon as I met him with his always smiling face and positive attitude. But the tipping point that almost brought me to tears was as I was leaving the first visit and asked him if he had any particular goals I could help him accomplish. I was prepared for all the things I would have heard from a typical patient in the states that would have started with a lengthy complaint about how he can't even leave his house, but instead I got a single response. He wanted to be able to walk with some kind of assisted device across his house, a total of less than 20 feet. I was in awe of the simplicity of his request and how much he appreciated what we were doing for him. I never got to see him independently take his first steps, however I have never seen a patient who was more motivated towards a goal and willing to work so hard to get it.
AJ: There is no one experience that embodies my time in Belize. Every patient, every Belizean staff member at the clinic, every health care colleague, every volunteer preceptor, and every individual who gave assistance while traveling on the weekends have engraved themselves in my heart. The hospitality I received from every individual I interacted with motivated me immensely every day to overcome all of the adversity I faced during the rotation and continually reminded be to express my gratitude for such an amazing opportunity to all of those involved at Hillside and back home at SLU.
|Anna, "AJ," Van Alstyne stands in front of the Hillside Health Care Center sign.