Efosa L. Guobadia, PT, DPT
In the spring of 2010 I found myself sitting in Father Tim Cadigan’s office looking for answers. I was looking for something without knowing what it was going to look like or sound like. Father Cadigan is a priest and professor at the University of Scranton, the institution that I received my Doctorate of Physical Therapy. I had become familiar with his warm encouragement and words of wisdom and I knew that his office was the place I needed to be at that moment. It was my last day on campus and my car was packed, and here I was after three years of studying, and practicing, and testing my way to being a physical therapist – I found myself asking the question of ‘what’s next’? I had queries of where do I go and when? What exactly do I do and how? Father Cadigan has a background in the sciences and we talked about physical therapy and how it is a healing profession and one in which you get to use your heart as well as your hands. It was a unique profession he was telling me and he thought that I would be able to do good things. Suddenly towards the end of our conversation he led me to a beautiful picture on the wall. A picture of sharp mountains, wide valleys, and a horizon that was unending. Father Cadigan pointed to the picture and said to me: “You see those mountains; you see those valleys – go there – climb those heights and explore those depths. Go there!” Instantly I knew that I had heard and saw what I was looking for. Then and there I made the decision to enjoy the ride and to make an adventure of it all. I got into my car and drove home ready to charge into my future.
That experience was highly important as I started my career and I suspect will always be central to what I do and how I do it. I was lucky enough early in my career to grasp on and indentify things that I love and things that speak to me. I love to treat as a physical therapist with all of my heart. I love to travel and to meet new people as I affect them and they affect me. I love to serve because I know that in service there is growth and there are ripples that are possible that can’t be quantified. I love the new and unknown and the mystery that they entail. Happily I have been able to combine those elements into service trips abroad and service initiatives at home. As of this writing, I have done eight mission trips since starting physical therapy school and I have learned more about the world around me and about myself, than I ever hoped to know. I have learned that we have more in common than we have apart across different countries, religions and creeds. I have learned that a genuine hug and a smile can be the beginning of curing many ailments. I have learned that when going into the unknown you can be aware without being afraid. It has made me a better clinician, professional, and person.
What these Mission Trips Consist Of
When I travel on these mission trips we go to places that are underserved and in need, and we try to provide services and to fulfill those needs in any way that we can. I have been to regions of high needs and low resources with groups big and small. When travelling with big groups of different disciplines I am always struck by the harmony and coordination that exists. In a way that is not always seen in the states, we are all pulled together with smooth and fluid flow. When we do a mobile clinic we will go to a remote village and set up at the center of town and at times there are 300 local patients waiting to be seen and the wait sometimes last for hours. Once a patient’s turn comes up they are triaged to one or multiple stops and then proceed to receive treatment that they need. In my experience my treatments have lasted anywhere from fifteen minutes to over two hours. Treatments consist of education to patient and family; exercises and stretches; manual therapy and even manufacturing. I have been part of groups that have helped develop and refine canes and prosthetics. When travelling with smaller groups of mainly physical therapists, our roles often expand to a role of triage in addition to our physical therapy services. When this is the case it is very important to know the resources on the ground so that you can help coordinate and refer as appropriate to local health clinicians. We see some complicated cases and the toughest cases are when someone comes up to you and says that everything hurts. Striking that balance of prioritizing and helping where you can and understanding when you cannot is very important. Quality healthcare access is usually reserved for or accessible only to those who can afford it in many of the countries that I have traveled in Latin America. For those with less money and in more remote regions, quality care is usually a combination of being too expensive and too far away. You also come to realize and understand that many people with pains and hurts have never had a health clinician put their hands on them and inquire about what happened, and when, and how and where. Those conversations and connections are never made and my belief has always been that for a successful rehab journey they very much need to be.
These trips have made me so happy to be a manual physical therapist that uses the combination of my hands as well as my words to educate, guide, cue, and treat to promote healing. Much of the foundations of my treatments are built on the functional manual therapy approach of the Institute of Physical Art (IPA). The teachings by two of my heroes in the profession, Gregg Johnson and Vicky Johnson, prepare a clinician to serve to those in need. Furthermore the IPA approach is easy to explain (even with language barriers) because it is so functional and it gets results right away! I’ve worked with patients who have come in with ninety degrees of range of motion and have left with over 150 degrees after one session. Now they have the increased ability to play with their kids and grandkids or work if their family needs them to. By changing their function we can change their lives. I’ve had relatives of local physician’s bypass other physicians both local and travelling and come straight to me after rumor of my treatment has gotten around. Inherent in these reflections are a reminder of the interactional power that exists within our profession of physical therapy and how we can make big impacts in a small amount of time.
When I went on my first mission trip a part of me was unsure of what we as physical therapists could really do in a short amount of time, especially since the nature of our trade usually happens over several sessions as well as weeks. I was also struck early on by how much need and problems that the world has. At a glance and certainly at first it can be saddening and engrossing because many of the problems are systemic, deep and hard. Yet over time I have been reinvigorated by the people that live daily in the places that I only travel to. Their strength and their often unshakeable happiness have been inspiring. The ripples and connections made have been sustaining. And the instant changes that I have been able to make with patients have been motivating. My experiences have shown me that we can indeed have an impact. The first step is believing that we can and then be willing to try. The next step is appreciating that every moment, interaction, and encounter counts and is special in its own way.
How can we take it further?
Beyond some of the improvements we have had with treatment I have begun brainstorming and acting on how can we ‘go and leave something behind’ instead of just ‘going and leaving’. For starters, in a recent trip in February 2014 we taught to local physical therapy students for a full day course. Topics ranged from posture education, stretches, exercises, differential diagnosis, and shoulder joint mobilizations complemented with appropriate grades, indications, and contraindications. It was one of the more rewarding parts of the trip as we were tasked with giving the students something they could use right away along with stirring their curiosity with potentially new tools. We hope to continue this on more upcoming trips and to motivate other groups to link up with local students and practitioners wherever they go. In addition, myself and a work group are in the early stages of planning and developing a short term intensive stroke camp in Guatemala, specifically to the region I have been to three times. It would include full day treatment sessions to patients along with education delivered to care takers. An idea on the horizon is to facilitate continuing education groups to work together to provide large scale low cost or free education to PT’s and other health clinicians in Latin American countries over the course of a week. By creating ripples like the ones above as well as creating new ideas we can help to raise the basement and the ceiling of our profession and play a part to make this a more functional world. If you have ever had any inkling to serve outside of the clinic walls it is very doable, whether it is done in the states or abroad. When we strengthen our communities we all grow strong. My journey as a physical therapist and my learnings from school, work experiences, and the IPA has helped me to tap more and more of the potential in myself. My hope and goal is to use whatever skills I have to help others tap and reach their own full potential. As my mentors and heroes Gregg and Vicky say: it just makes sense.
Efosa is the Founder of Physical Therapy Haven. He received his B.S. in Kinesiology from Umass-Amherst, and his Physical Therapy Doctorate from the University of Scranton. He is driven by his love for this profession which allows us to use our hands and words to help others. The site contains rehabilitation resources geared towards rehab clinicians and it includes videos, study guides, as well as links to other useful sites.