Physical Therapy in Haiti

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Physical Therapy in Haiti

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Our own Amanda Gotschall PT,DPT who works at our Louisville office had the amazing opportunity to travel to Haiti to provide much needed medical services there.  Here is a blog about her experience:

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Haiti is one of the most underserved areas in the world. Most Haitians have little, to no access to health care and not until recently have Haitians been able to receive basic education to be able to become allied health care providers including nurses and physical therapists. Therefore, many Haitians are left without access and rely on “voodoo doctors” for all of their ailments. These services are expensive and tend to be insufficient; providing temporary, if any, relief.  I had the opportunity to go to Haiti with the support of N2 physical therapy as well as many generous donations from family, friends, and patients.  Myself, along with 20 physical therapists, a nurse practitioner, physicians assistant, orthotist, prothotist, and support staff were able to touch over 180 lives per day.  My experience was eye- opening and I felt like what we provided was valuable and life-changing.

I came away with a better understanding of a few things. The first is cultural differences and communication barriers. Every patient has a different perspective and understanding of pain. The Haitians have a very high tolerance for pain because the “voodoo” doctors will treat them with leeches and spikes to rid chronic pain. You can tell if someone has had this treatment by the scares oriented on their backs in a very particular pattern. Despite these aggressive treatments, many reports little, if any, relief. I found myself focusing the treatments on  education to prevent pain as well as using a technique called “trigger point dry needling”. Many Haitians found dry needling extremely helpful for immediate reduction in their pain and my job was to make sure they maintained new movement patterns to prevent return of their symptoms. However, the biggest barrier was communication due to the fact that we were using Haitian translators and inevitably my specific instructions were distorted. I am hoping they will be able to maintain their movement patterns and help manage their pain with the exercise I prescribed.

Additionally, I was shocked by how many patients suffered from “vaginal infections” or “abdominal pain”. Many had unremarkable  diagnostic testing from the the NP (nurse practitioner) and PA (physicians assistant) present at our clinic and many most likely had “pelvic pain”.  I was able to treat some of those patients with fantastic results, but many that could and should have been treated for pelvic dysfunction were not. Yes, this is slightly frustrating, but it is also very encouraging because it means for the first time the founders and presidents of STAND now know going forward how to screen for pelvic floor dysfunction and also logistically what is needed to make sure the patient is getting the most optimal care possible. I find that a true success!

Lastly, there was notable differences between the USA and Haiti’s movement patterns. To over simplify this observation, the people in Haiti are very active and walk a lot because other forms of transportation are limited and also expensive. When they need to carry food or other things, they walk with those objects on their head. This means that many people are walking and standing with heavy amounts of weight and are compressing their spine daily.I would say that many of the Haitian people would benefit from a very simple exercise routine that consists of core strength and stretching the quads/hip flexors. On the contrary, many of our jobs and daily activities require us to sit. We already know sitting too long can be detrimental. Sitting tends to lead to tightness more in the hamstrings and back of our hips. The main thing to remember is our movements in daily life can lead to tightness in the hips so stretching the hips along with core strength will also help us, we just need to stretch slightly different muscles than the Haitian people!

Overall, my trip to Haiti was unforgettable and hopefully very impactful. The people of Haiti have very little access to health care. I would have loved to see each person for a full plan of care but I found that even with one or two visits we were able to educate every patient through the door how to manage their pain and symptoms and get them moving again. This was very rewarding and made every ounce of my hard work worth it!

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Amanda Gotschall, PT, DPT
amanda@n2pt.org
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About the Author:

Terri Nishimoto
Co-founder of N2 Physical Therapy, Terri received her Physical Therapy Degree from the University of Colorado Health Sciences Center.

Terri brings a diverse background in neurological, orthopedic and sports medicine physical therapy to her practice, and has expanded her focus to include pelvic floor rehabilitation, perinatal and oncology physical therapy. Terri holds certifications in the Feldenkrais Method, Manual Lymphatic Drainage and Trigger Point Dry Needling.