A Better Health Care for All

By Domenic F. Fraboni

“Where’s the duct tape?!” Who has my duct tape?!” “Can someone loan me a roll to make a corner chair for this patient with cerebral palsy?” These are phrases you would likely never even think of hearing in a United States hospital. However, the situation in Honduras is quite different. A group of nine Mayo physical therapy students, led by their fearless leader Dr. Nathan Hellyer, spent their spring break treating patients in Rancho El Paraiso, Honduras. Their most valuable piece of equipment: duct tape. I’m going to use this article to tell you a little bit about the invaluable trip our very own Mayo second year PT students had, but also how this trip allows for a better health care, for all parties involved.

It is no secret that health care access varies widely across the world. In research done by Grobler et al. (2015) they found that 37^% of world health workers work in the WHO Americas region where only 10^% of the global disease burden is present. The WHO Africa region lies on the other end of the spectrum, housing only 3^% of the world health workers and 24^% of the global disease burden. A very similar trend can be seen within countries alone, including the United States of America. In South Africa, only 25^% of the medical specialists serve the rural areas that make up 46^% of the population. Similarly, American rural areas that comprise 20^% of our population are treated by only 9^% of America’s registered physicians (Grobler et al., 2015). I think you all can guess what end of the spectrum rural Honduras sits on.

In rural Honduras, on the beautiful Rancho El Paraiso, sits Clinica Dan Patillo. This clinic’s staff is comprised of a single physician, full time functional therapist, and a few nurses. During one week of every year (for the past nine years now), our Mayo PT students help bolster up the clinic staff. Over these years the Mayo crew has been forming a relationship with functional therapy students (a similar, but much broader, profession to physical therapy) from Tegucigalpa, Honduras. The functional therapy profession in Honduras is a relatively new one. It has been created in response to their realization that a rehab unit is a very important piece to the health care team.

Due to their rehab profession being in its infancy, functional therapists act as a much broader profession than physical or occupational therapy alone. They focus mainly on what the profession’s name says, improving function of patients through movement. Their program has grown steadily yearly during their partnership with the Mayo PT students. This year 27 Honduran functional therapy students were there for the week. All of the students were split up into teams and put to work at a clinic with no gym and very little of their “normal” equipment on patient cases that you would rarely see in the states. Oh not to mention, the language barrier made charades and Pictionary skills very valuable.

Over the course of the week, our student teams treated upwards of 80 patients. The mornings were spent primarily seeing patients in the clinic, and in the afternoons some of the teams would conduct home visits to the nearby village. Our students quickly learned that creativity would be a key attribute to have treating patients in this setting. They did lug a limited amount of supplies with them to Honduras: 4

wheelchairs, 5 walkers, 5 canes, wooden crutches, a rolling walker, seat cushions, wound care materials, some braces, straps, immobilizers and wraps, therabands, and duct tape. Glorious, glorious duct tape. Some of the equipment worked wonderfully. For example, a pediatric wheelchair was fit perfectly to a thirty-year-old women suffering from severe osteogenesis imperfecta. Not all of the equipment fit so perfectly however. Second year student, Tyler Berling, recounted a story about a woman they treated with a “massive” (roughly 2”) leg length discrepancy. To help her out they pieced together a transferable wedge that she could transfer between all of her footwear. The students further cut a wooden crutch into a cane so this woman could rehab pathology she had developed secondary to walking two inches lopsided for so long. This gives a quick example of the creativity that resulted in some very effective treatment for these patients who otherwise would have no help.

My second year colleagues also seemed to agree on another common theme. This trip was an amazing opportunity to foster interprofessional skills with their Honduran counterparts. The functional therapy students were able to give them great insight on common disorder and pathology seen in Honduras as well as great functional and facilitative techniques our students were able to bring home. Our students were also able to bring a wealth of knowledge more specific to physical therapy to reciprocate the information exchange. Nonetheless, our students take way more than a week of patient care out of their experience.

Duct tape. Second year student, Sara Balch, said those who go next year may just want to clean out an Ace Hardware of their duct tape stash before we go. However, aside from learning how to utilize duct tape in patient care, our students learned how to be creative with lack of resources and equipment, overcome language and social barriers, work with pathologies very different than you see in Minnesota, and develop great interprofessional dialogue with many Honduran functional therapy students. All of this was done while helping balance the Honduran health care access scales. Now tell me that that isn’t helping to provide a better health care for all.

Acknowledgements:

A huge thank you to the PT program and Dr. Nathan Hellyer who have helped make this trip possible for our students. Thanks also to the Mayo PT alumni who helped to provide scholarships for our students to cover some of their expenses for the trip. I think one of the biggest thanks should go out to the second year students who went on this trip and were willing to allow me to share their story on the blog.

Author Note:

I have luckily been able to get to know the second year students very well as a first year physical therapy student here at Mayo. Hearing about their experience has fostered my own interest in international health care experiences and hope to use my education in that way in the future. As one of the current student blog managers for the Diversity in Education Blog, I am also glad to be able to share this experience with all of you.

Reference:

Grobler, L., Marais, B.J., & Mabunda, S. (2015). Interventions for increasing the proportion of health professionals practicing in rural and other underserved areas. Cochrane Database of Systematic Reviews 2015, 6. doi 10.1002/14651858.CD005314.pub3.