UnBELIZEable!
When I started on my journey to become a physical therapist in 2011, I wasn't quite sure where I would end up. One thing I did know was that I wanted to travel the world, and ideally while practicing physical therapy. On August 14th, I got a taste of that reality. Thanks to the United States National Member Society of the International Society of Prosthetics and Orthotics (USISPO), I was able to participate in a week long student service trip to the country of Belize, where we provided physical therapy for individuals with lower extremity amputations. Although this type of service trip is new to the ISPO Organization, it was led by veterans in international service including: Rob Kistenberg, the co-founder of Prosthetic Hope International, and Jon Batzdorf, Chairman Emeritus of the USISPO. How would I describe this experience? Simply UnBELIZEable!
Tuesday, August 14th
We started our service trip in Belize City, and literally hit the ground running. After gathering our bags from baggage claim we headed straight to the makeshift prosthetic clinic formed out of a classroom at the Stela Maris School - Belize Academy for the Deaf. We dropped off the prosthetic and orthotic team (preferably referred to as O&P, not P&O), while the physical therapy team headed off to a tour of the main hospital in Belize City, Karl Heusner Memorial Hospital (K.H.M.H.). We were immediately informed by the primary hospital administrator that we came at a "bad time" because the hospital was in the midst of an architectural crisis after a failing beam in the roof caused diffuse damage resulting in the closure of several departments and patient evacuation. As we toured the dimly lit hallways we saw electrical wiring hanging from the roof, medical equipment crowding the hallways, several hospital employees hard at work with no escape from the heat - it was shocking to a group of Americans, that’s for sure. In the midst of all the chaos, there was a beam of light at the end of the tunnel as we approached the hospital's NICU. K.H.M.H is home to the only NICU in the country. It was beautifully re-constructed with pastel painted walls and stocked with state of the art equipment. The reconstruction was the result of $4 million dollars' worth of donations collected under the direction of Kim Simplis Barrow, the wife of the Belizean Prime Minister.
We learned that not only does this hospital house the only NICU in the country, but also the only catheterization lab for urgent heart procedures, and they have employed the only doctor of physical therapy in Belize. The physical therapy department was a small square room equipped with a treadmill, parallel bars, three stationary bikes, three treatment tables, one mat table, and a variety of TheraBands and Swiss balls. It was the most crowded space I had ever seen, but they were making do. Dr. Holder, the solitary doctorate level clinician of Belize, is a graduate from the University of South Florida physical therapy program. She worked in the United States for about 5 years before accepting her position at K.H.M.H. She had the most pleasant aura about her, always smiling, and she laughed often during our brief conversation. To willingly leave the luxury, comfort, and spoiled nature of the United States, and work in a public hospital that only charges $30 Belizean dollars ($15 US dollars) for an initial evaluation, requires positivity and joy that comes from within, a peace that comes from the satisfaction that your service is not just valuable, but necessary and genuinely appreciated. At the conclusion of the tour we all agreed on one thing, the work force behind that hospital was doing everything within their power to provide the best possible care with what they have.
When we returned to the pop-up prosthetic clinic at about 4:00 p.m. that afternoon, we found our O & P colleagues hard at work. They had been casting limbs to make prosthetic sockets non-stop. The physical therapy team did not have any specific assignment for the day, so we decided to be useful by administering physical therapy evaluations for the patients that were lined up outside in the afternoon sun, patiently waiting their turn. Considering we were outside in the grass courtyard of the school, we focused on the essentials: a good history, sensation, range of motion, strength, skin assessments, and balance. Using this information we were able to construct a vague idea of what gait training might be like when these individuals returned to receive their prosthetic limb that weekend.
Wednesday, August 15th - Thursday, August 16th
On Wednesday we geared up for a full day of work in Belize City at the "physical therapy workshop", designed to tend to the needs of all the hopeful Belizeans on the waiting list to receive a prosthetic limb. Our objective was to evaluate the physical status of the patients, determine if they would be good candidates for a prosthetic limb, and provide them with education and a home exercise program that will best prepare them for receiving a limb and learning to walk on two feet again. Of course nothing went as planned, especially when about half of the patients in attendance didn't even have an amputated limb. Apparently the word spreads fast in Belize. When the locals heard from their friends with amputations that the "American physical therapists" were coming to town, loddy-doddy and everybody came along to see what we had to offer! Amongst our patients with amputations we also saw diagnoses such as stroke, venous insufficiency, generalized knee pain, and post-surgical neuropathy. We had no choice but to provide services individually because all of our patients were so unique. It was a long day's work in an empty room with no air conditioning, 4 ceiling fans, 3 picnic tables and a collection of lawn chairs for seating. We made do - the good old Belizean way.
That afternoon our physical therapy team separated; three of us went to Orange Walk Town to meet up with the O&P team, while the remaining three headed to the capital city of Belmopan for another "Physical Therapy Workshop." The taxi ride from Belize City to Orange Walk Town was about an hour long commute traversing one main highway for the entire ride. When we arrived, not to our surprise, we found our O&P team hard at work, turning the casts they made the day before into prosthetic sockets. There were very few patients -- a few walked in for repairs to their prosthetic limbs. I found myself feeling pretty useless. But I remembered a lecture that Dr. Hunt from the University of Miami gave about his experience with international service work. I remembered the many examples of how he made himself useful - and how others sat around and watched people work their fingers to the bone since "their part was done". I didn't want to be the latter. We began looking for work; we asked the O&P team if there was anything we could do to make their lives easier. They taught us how to cut materials that would be used for the lamination of the prosthetic limbs - we gave it our best shot!
On Thursday, we knew we would experience more of the same: very few patients and lots of prosthesis making. This time we made ourselves useful by re-organizing the stock room. We dismantled an entire closet full of unorganized prosthetic socks, and reorganized them by function and ply. Some may call it busy work, but it was better than doing nothing. Future service groups will appreciate the ability to easily find the correct ply socks to supply those in need. We did get a tiny drop of luck, when a patient whom we will refer to as Toby (for HIPPA's sake), walked in on two crutches and one leg for a late casting session of his transfemoral residual limb. He had a huge smile and didn't speak a word. Neither could he hear a single thing we were saying. However, he made it clear to us that he was not new at this. He had owned a prosthetic limb before, and was confident he would do well with a new one. He was strong, flexible, no contractures, incredible balance, and a beautiful sound foot with no wounds, calluses, missing toes, or any sign of wear and tear. At 60 years old he was doing just fine, taking care of himself and living his best life. How did we find out all of this information? We very quickly learned how to speak his sign language. We made eye contact, we connected, and we figured it out until we all had the grin of satisfaction on our faces, signaling that we were on the same page. It was absolutely incredible to work with him, and I was very excited to be assigned to him for gait training when he returned.
Friday, August 17th Friday was our one fun day! As a group we took a trip to Lamanai, a gold mine for ancient Mayan culture and preserved ruins. Our tour guide, Colin, from Lamanai Ecotours Ltd. took us on a 25 mile speedboat ride down the Belize New river. He stopped at every opportunity to show us the unique animals, birds, plant life, and culture of Belize. About half way through the tour he slowed down so we could catch a glimpse of one of the Mennonite towns. The Mennonites are a small private group of devout Christian German descendants who are passivist in nature, avoid technology at all costs, live off the land, and govern themselves quietly in their own unique way. We might compare to them a more well-known culture like the Amish. They are valuable to Belize as they cultivate some of the country's largest farms and crops. And in spite of wanting nothing to do with technology, they are reportedly the best mechanics in town!
When we arrived in Lamanai, the sky was at the brink of bursting into a full-fledged thunder storm. We waited out the storm by touring the indoor museum and enjoying a homemade lunch featuring the Belizean favorites: rice, beans, stewed chicken, plantains, watermelon, coleslaw and the extra spicy "onion sauce". Once the sun peaked out we hiked our way through the site, climbing ancient Mayan pyramids along the way, taking breathtaking photos, and playing with gigantic tarantula spiders (I watched the spider antics from the sidelines). All in all, it was breath taking. I did not expect Belize to have such a rich history and culture associated with the ancient Mayan civilization!
Saturday, August 18th - Monday, August 20th The remaining three days in Belize were what we had all been waiting for. It was time to see the fruit of our labor and watch our patients walk in their new prostheses - some of them for the very first time. Our PT mentor, Debbie Nawoczenski, ensured that each of the PT students got some experience gait training individuals with both transtibial and transfemoral amputations. My favorite patient, Toby, returned to the clinic for a third time on Monday. He was on a time crunch and needed to get his leg and go! His knowledge as a mechanic gave him a unique perspective as the prosthetists and I worked together to normalize his gait. Although he couldn't speak or hear, he knew exactly what needed to be done to make his prosthesis operate more efficiently. He quickly let us know that he did not like the terminal impact he was feeling every time he reached terminal swing. He asked politely if we could tighten the springs on the extension assist. Unfortunately, with the limited tools available it could not be done, but the prosthetist worked on increasing the friction as an alternative. Toby spoke to us with his hands and eyes "A little more friction please. Now, a little less. This is good enough - I like it right here."
After all the adjustments were to his liking, the prosthetist began to tighten all of his screws. Toby took this opportunity to make one final joke at me. He gestured "Why aren't you doing this hard labor like the prosthetist? You're strong enough to tighten these screws. But instead you want to put this silly gait belt on me again and try to hold me while I walk as if I'm a baby!" He broke out into silent laughter, and I couldn't help but laugh along with him! I was trying to do my best to uphold the number one physical therapy safety rule, however, on the first day we met I knew a gait belt would never make sense to him. This man, who is deaf and mute with one leg and a pair of crutches, goes to work and fixes cars every day, makes his own transportation arrangements to get around from place to place, fixes the rubber ends on his old faithful crutches using scrap metal and melted tire rubber - and he does all of this without a gait belt. He didn't need much from me, just a few small taps on his gluteal muscles to remind him how to stabilize the limb during stance. That was it. He was going to make do with the rest and just keep on going. That's the spirit of Belize.
Tuesday, August 21st
Early Tuesday morning we prepared to say good bye to Orange Walk Town - a place that now was all too familiar to us. I had to be sure my last meal in Belize was a Belizean favorite: the famous stuffed fried jacks! Light fluffy pockets of funnel-cake-like dough stuffed with eggs, beans, and cheese, fried to perfection with a side of salsa and local fresh fruit! Although my breakfast was fantastic, it was my final encounters with the people of Belize that left me grinning from ear to ear. The first was a conversation I had with Frank, an afro-Belizean who we saw daily at our hotel socializing with the employees and doing odd jobs to help out. As we waited for our van to load up, he looked me in my eyes and began to tell me about the amazing grace of God that he experienced in his life. He told me that no one can tell him that Jesus is not real, because Jesus saved his life. He acknowledged all of the good work that we came to do for the people of Belize, and reminded me to give God the glory, because it is only by Him and through Him that we are capable to serve His people. I will never forget that.
The second encounter occurred in the airport as I was shopping around for a few last minute souvenirs. As I went to check out, I heard a very familiar song playing from a radio behind the register. It was "Break Every Chain" by gospel artist Tasha Cobb - and the Belizean woman operating the cashier was singing it very loudly. She sang until I finally approached the counter and I said to her, "I like this song too!" to let her know that she was in good company with me. Belize is a place where the people are not afraid to believe. Obviously I can't speak for everyone in Belize, but those two experiences along with nearly every patient that I saw, who in spite of everything they may have lost -- including a whole limb -- gave God the glory for the life that they have now. That will forever stick with me, and it encourages me to continue to not just have faith, but to be unashamed of my faith in Jesus and boldly acknowledge Him for all that he Has done for me! #sorrynotsorry
After working with about 54 Belizean individuals, I'm sure my service team colleagues would all agree that the people of Belize are amongst the most
resilient, kind, patient, creative, and motivated individuals we have ever treated. Some of these individuals have been waiting for years to receive a limb, but you wouldn't know it - because they don't waste time complaining about it. They come with high hopes that cannot be destroyed. You can see the hope in their eyes. It's as if with their gentle warm smiles they say, "If not this year, then next year." And they faithfully return year after year, patiently waiting for the opportunity to walk on two feet again. But if the opportunity doesn’t come - trust and believe the people of Belize aren't going to skip a beat. They just keep on living!
On a waiting list of over 130 people, we were able to gift 11 people with a lower extremity prosthetic device and gait training over a span of seven days. It is a slow process, and there is more work to be done. Which is all the more reason that if you are interested in the amputee population, you should consider becoming a member of the USISPO so that you can contribute your knowledge and skills to deserving individuals all over the world! (To learn more click here!) This service trip opened my eyes in so many ways. Yes, I got to explore another country, but more importantly I learned that physical therapy is not just possible, but impactful no matter how scarce or limited resources are. And finally, I was blessed with the opportunity to experience the true potential that motivated patients have. If their mind is made up to do what seems impossible, then naturally, everything becomes possible - truly unBELIZEable.
(P.S. don't forget to give God the Glory! And a special thanks to Marsha Gillett for coordinating our service work in Belize with Prosthetic Hope Internantional , managing all of the patients, and for just being amazing. We miss you!)
