May 4, 2017

Providing Physical Therapy in Rural Honduras

By Domenic Fraboni

By: Jordan McGowan

In February of 2017, I traveled to Honduras with other members of the physical therapy program from the Mayo Clinic School of Health Sciences: one professor and 3 students. Our mission was to meet up with functional therapy students at the university in Tegucigalpa, Honduras and travel with them to a clinic to provide care to patients who would not otherwise be able to receive treatment. It was by far one of the most influential experiences I've had in my life.

The first couple days were unlike the rest, as we stayed in Tegucigalpa. We flew in on Friday, settled into our hotel, and ate at a Honduran restaurant to explore the local cuisine. On Saturday, we attended a conference at the Universidad Nacional Autónoma de Honduras.  It was a great way to get introduced to what the students in the program are learning and to get familiar with some of the students before heading to the ranch. We left for Rancho el Paraiso on Sunday. We traveled in a bus with the entire group, which consisted of about 25 Honduran students, 2 doctors, 3 physical therapists, 1 medical resident and 4 American students. In a typical day at the ranch, we would wake up around 5:45am and eat breakfast at 6:15. There was a devotional (meant to bless the ensuing/proceeding week of patient care) on Monday and Friday before we saw patients in the clinic at 7:30. The clinic consisted of a waiting room and approximately 8 treatment rooms in a ring with an outside courtyard in the middle.

Two Mayo DPT students and a Honduran functional therapy student working in the clinic. PC: Sam Nelson

In the clinic, we were divided into groups of 4-5 under the direction of 1-2 physical therapists and/or a doctor.  I was excited to be placed on the pediatric team, because my patient population consisted of kids! I was responsible for examining and evaluating patients and prescribing them interventions. We worked together as a team to do this, but as the only American PT student in my group, I had a unique perspective that I could express in each case. This team dynamic was one of my favorite aspects of the experience. In my group, I had 4 unique lenses that were being used: a medical doctor, a pediatric physical therapist, the Honduran students' perpectives, and my own. After treating patients in the morning, we would go to lunch at 12. Meals were fantastic at the ranch, consisting of a lot of meat, soda, rice, beans, and fruit!

After lunch, we would most often divide into larger groups to go treat patients in the community. We would hop into 12 person vans and travel up to 30 minutes to different locations. It was rewarding to see patients that otherwise did not have the means to get to the clinic on their own. Due to the larger group size, my responsibilites during these expereinces were slightly less, but I was still able to give my opinion as to what should be done with patients and learn from the entire group. When we got back frm these experiences, we would often play soccer for a couple hours before supper. I had to be on top of my game, as the majority of the Honduran students were really good! Supper was at 6pm and was always delicious.

The fantastic four Mayo students that traveled on this Honduran adventure. (Left to Right - Kayla, Samantha, Heather, Jordan) PC: Samantha Nelson

One regret I have about the trip was that I would regularily sit with the American students and staff. If you are thinking about taking part in a similar experience, I would recommend getting out of your comfort zone and sitting with those from different countries whether or not you understand their primary form of communication! Every group washed dishes one night of the week, and afterwards, we would gather for a reflection of the day at 7:30. These reflections were meant to share interesting cases that each group had been exposed to during the day, to increase our awareness of what the other groups were seeing and doing. We would then go back to the dorms, chat, play guitar, shower, and go to bed.

During this experience, I grew both personally and professionally. I would say the majority of my personal lessons came from the Honduran students. For their education, they have 3 years of extra education beyond high school until they are permanently in the clinic. If I were to compare their confidence and knowledge to what I knew 3 years out of high school in my junior year of college, it wouldn't even be a contest; they are very professional and knowledgable. I admired their confidence with the patients and their ability to connect with patients immediately. It taught me that I should surely be confident with what I know, as it creates an invaluable connection with patients. If patients see me as confident, they will be much more likely to adhere to my recommendations and thus, improve. Another thing I admired, which I have already alluded to, was their ability to forge personal relationships with everyone they met. There was often a language barrier between me and the students, and though I consider myself pretty good at Spanish, I was sometimes still out of the loop. Despite all this, every student I met was able to make me feel like they were my best friend in the world. I was inspired by their desire to get to know me personally. I aim to employ this in the future to new and old relationships in my life.

Mayo students and their professor playing soccer with some functional therapy students. PC: Sam Nelson

Professionally, I would say I learned most from the doctors and PT's.  I learned a significant amount about how to interact with pediatric patients from the doctor in my group. He taught me how to provide the best care even when children were not in the mood (crying and screaming)! It was good to watch the dynamic between the doctor and physical therapist in my group, as they had very different lenses, yet respected each other's opinions and ideas. Furthermore, I admired the staff of HOI's resolve to treat the patients who really needed to be treated. I sometimes thought that we could treat more patients if we just stayed in the clinic and let the patients come to us, instead of going out to the community to treat 1 patient. However, it was a good lesson in patient care to treat the patients who desperately needed treating, even if it's not the most efficient or easiest. In America, we often strive for efficiency. It does not often make sense economically to treat a certain patient when we can treat two others in the same time frame. However, I will strive to put my patients before my own desires to provide the best care I can in the future.

This experience allowed me to grow immensely. It provided me with new lenses that I can use to treat patients to the best of my ability, I was able to learn about different cultures, I was given experience working with diagnoses that I may not see in the U.S., and I was able to apply the knowledge I have learned at Mayo to help others in need. I cannot adequately express my gratitude for having been given this wonderful adventure.

Author Bio:  Jordan McGowan is a second year Doctorate of Physical Therapy student in the Mayo Clinic School of Health Sciences. Other than having a promising future as an incredible Doctor of PT, Jordan likes to unicycle, play frisbee, and compose music… all at the same time.

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