PTDOS and Fundraising Event

After a celebratory beer and working on powerpoints Friday night, I woke up at 5:30 am on Saturday for our PTDOS event. I was ready at 6:15 am but Haitian time took over and we did not get going until 6:45 am. It gave me time to watch the beautiful sunrise again and reflect on the week.

For the PT Day of Service event we went to the town square to pick up trash. The square has heavy foot traffic and is a meet up spot for many people. With more people comes more trash. Sadly a majority of the people throw the trash wherever they are standing leaving the sidewalks and grass covered in Styrofoam boxes, bottles, bags, and wrappers. The students said that some workers come to clean the area at times but it is inconsistent and people tend to just litter again.

Our group was about half the size that we expected due to family commitments and time of the day. However, the seven of us were able to fill 20+ bags of trash this morning. We worked hard and tried to show the young children watching what a difference cleaning up can make. The students explained that children are not taught much about trash, the environment, or sanitation growing up in Haiti. Two of the students reflected after the project the need to educate the community on sanitation and keeping the streets clean. They felt that doing this could really help the health and stability of the city.

In the afternoon I traveled with Janet, the Dean of the PT/OT program, to port au prince for a fundraising event to support St. Vincent school.  The school houses and teaches children with special needs.  The school is what brought the vision of a PT/OT program at FSRL to life.

The event was a fundraiser located at Hotel Keribu which is one of the nicest hotels in Haiti located in the nicest region of Haiti. The resort was first class with beautiful buildings, artwork, and attention to detail. The event put on tonight was a Kids Halloween Bash. They went all out with moon bounces, trick or treating stations, a haunted house, and full stage with music and entertainment. I was introduced to a few board members, nuns, past students, and local healthcare students. On the way home I had a great discussion with Janet about the even as well as deeper topics of internal drive and life lessons. I really enjoyed seeing another aspect of Haiti to finish off a great week.

Overall this week has helped me to develop as a global thinker, educator, therapist, and man. I am excited to return home to implement some of the lessons I learned and spend time with my wife and pup. I hope you enjoyed reading the posts. 

Teaching Day 5

A beautiful sunrise and reflecting read is how I want to start more mornings when I return home.

Final day of class was focused on practicals. The final four students completed the patient practicals without a hitch. The patients became much better actors, the students seemed more comfortable with the pressure, and the flow was very sound.

After a morning of testing, I sat down with each student to reflect on the week and the exam.

We had our final meeting before lunch where I told them that this was the first course I had ever produced and lead as a professor. Everyone gasps and started laughing. I thought they were laughing at me but I found out from the student who spoke fluent english that they assumed I did this often. I was honored to hear that my nervousness and lack of experience did not show to the students. However, I bet it makes more sense to them of why I gave them the tests with the answers on the flash drive the first day and fumbled with trying to hand out the exams and papers.

I ended the class by getting sappy and telling them how much of an impact they have made on me and strengthened my passion for global health and teaching. This 4th year physiotherapy class from Haiti will hold special place in my heart as my first students. After taking this final picture I looked back at the first picture and can see how much closer we all became (literally and figuratively).

After lunch I did a little workout and followed that up by traveling with one of the students to the market to purchase some supplies for our PT Day of Service event tomorrow. He went to the Mayor at lunch to gain a stamped approval for our event giving us the green light to finish planning. We will be doing a trash pickup in the downtown area at 6 am! Myself and 18 physiotherapy students will be working hard to impact the community. For these students, this is the SECOND PT Day of Service event they will be doing in 2018. The first was a free clinic in the local church last weekend. These students exemplify the expression "those who have the least give the most". I feel blessed to be able to work alongside them and serve in the same community.

Dinner was a fresh fish. It tasted as good as it looks!

After the meal I spent some time working on another powerpoint for a presentation coming up and enjoyed a celebratory Prestige.

Cannot wait to tell everyone how the PTDOS event goes tomorrow!




PS: We are in need of a manual therapist to teach the second week of this course. If you are interested please reach out and we can talk more about this opportunity. The students are begging for more and we need someone who knows the skills to come teach. I have already created all of the coursework for the entire second week.

Teaching Day 4

Over halfway done the class may be fun for the students, but very stressful for a professor trying to complete all of the content and feel accomplished in passing along the information.

The students started the day by doing cases to prepare for the practical. They have never done a mock practical or practiced doing patient care on each other with prepared scenarios. Most of their early classes were spent learning as much content as possible. I was fortunate to be able focus on clinical reasoning and combing already learned material with advanced skills. They had done a great job up to this point learning and reasoning through the various aspects of patient care. I was very excited for them to put it all together with one student acting as a patient and another acting as a therapist.

Sadly the activity did not go as smooth as I envisioned it would go. The patients were not used to acting and the ability to think on their feet when the therapist did certain tests was unfamiliar. The therapists were also not used to following their own structure and flow or working with patients who were acting which made it a struggle. Even with all of the challenges of doing something new, they worked hard and upon reflection stated they enjoyed the experience and could see how it would benefit them when out in the clinic. Taking something completely foreign in stride without complaints shows the adaptability of the Haitian people. We spent some time after the exercise allowing the students to give each other feedback and they really respected the opinion of their peers.

I had my final meal with three of the Notre Dame members before they head back home tomorrow. They had a very productive week and progressed far with both projects in Leogane.

All of the students were in their seats early after lunch because they had been waiting all week for the next lecture/lab on manipulations. We spent time reviewing safety and purpose of manipulations. I emphasized the mechanisms behind manipulations and the application. In the lab portion of the class, they did a great job breaking the steps down and performing the skills very well. Each student was able to get at least on cavitation (the pop) between the thoracic and lumbar techniques. We do not judge success of a manipulation if you hear the sound, but when learning the skill you gain confidence and excitement when you are able to get that instant feedback. They were like kids on Christmas today!

(one student practicing a thoracic manipulation on me so I could provide better feedback)

The final part of the day was the final case practical for three of the students. The patients and the therapists took the practical very serious and did a great job. I was impressed how they improved from the morning attempt to the afternoon test. All three completed and came up with a solid examination, assessment, treatment, and plan. After they concluded and distressed, I sat down with all three of them individually and we reflected together on their experience this week, their strengths/weaknesses, and ways to improve as they transition into the workforce. I was humbled by the insight they provided me about my teaching style and their own growth from the few short days together.  I know I gained as much of them as they did from me and I made sure to express that to them.

After class today I was able to Facetime with Olivia and catch up on everything back home. She let me know that our Mortgage Specialist and Friend Marlin Beitzel with Integrity Home Mortgage had sent us something. When we closed on our house one month ago Marlin donated money to Olivia's school for education projects. He knew about my travel and medical mission work and decided to match that donation and supported this trip as well as SUPT Thrive service trips! We cannot thank him enough for not only helping us purchase our first home, but supporting us in our dreams as professionals and servant leaders.

Sad to finish the class tomorrow, but I am so happy how well the week has transpired.

Teaching Day 3

Today ended up being a national holiday in Haiti so the school was closed. I told the class I was here to teach and would teach if they wanted to come in. All 7 insisted on having class and one even stayed at a classmates home last night in order to be at class because he lives far away. The reason he needed to stay over was because the roads were going to be blocked around Haiti. The people were planning to protest today while everyone was off of work. The country has been in an economic crisis and the people are frustrated with the government and the upper class for "misplacing/not accounting" for billions of dollars. The protests ended up being mostly peaceful and allowed our day to go as planned.

The 8 of us sat in the quiet building and worked on manual skills for the thoracic spine, SIJ, and lumbar spine. We had to stop many times to explain critical thinking for patient care and the students even brought example patient situations from their recent clinical rotations. The discussion became so deep that we ended up still behind when lunchtime arrived. I would much rather be behind because of learning and passion than get done and students not learn anything.

During lunch I had a great discussion with one of the students about his path to physiotherapy school. He graduated from an english grade school and started his career as a translator for a non-profit. He went back to school as a rehabilitation tech and is now in the final year of the physio program. He talked about his professional goals, teaching, continuing education, and further formal education. The passion in is voice to grow and change was inspiring.

After lunch we had to plow through the treatment for pathologies of the thoracic spine, lumbar spine, SIJ, hip, knee, foot, and ankle. To make it reasonable, I selected three of the most common pathologies seen in the country for each body part. I provided them 2-3 common treatments for each based on current research and explained how to deviate based on the irritability and severity of the patient. This concept to deviate based on a specific patient and thinking on your feet was very challenging but something the students were eager to learn. As we progressed down the body, they began to think of the treatments and even get creative with their patients.

At one point in the afternoon the students began to express their frustration again about clinical rotations and the current treatment thought process of clinicians in Haiti. I let them vent but also wanted to provide a positive spin to keep them motivated. They went as far to say that they think the progression will regress if something is not done. I explained that the profession is strong, but I could see where updating the practice expectations, patient-therapist alliance, and research informed care could catapult it into the forefront of the medical field.

I also tried to give them ways to manage interactions with their instructors for their next rotations in the summer to help allow them to integrate what they have learned in school to the current practice patterns in a respectful manor. We discussed how they are the pioneers as first graduates of the physio program. They need to keep focused on a higher level approach to care and use what they have learned instead of following the "way it has always been" mindset. They will feel like outsiders in the workforce but if they keep doing it and more graduate, the workforce will begin to have more of the critical thinking therapists and less of the traditional style of care.

After class, I played a little more basketball with one of my students but also another from the 2nd year class. Could only play 4 one on one games before I was exhausted in the 85 degree sun.

After basketball, I did a little yoga, had traditional rice and beans with turkey for dinner, and sat with the Dean to discuss the second week of the course as well the the future of the program. 

I am very excited for the physiotherapy progression in Haiti with this program leading the charge!


Day 4 I can finally say I had my first Prestige after 4 years and all the taste hasn't changed. 

Teaching Day 2

It was nice to wake up only one hour early to the sound of the rooster outside of my window. I was able to do some reading and catch up on emails as I waited for breakfast. After my meal I headed over for the flag and we began class at 8:15 am.

Today we were in the dormitory for classes. Currently the nursing program has priority over classrooms and the physio class uses the common room of the dormitory for class. We had a fan when the power was on and windows open to provide some breeze. I am glad I did not wear my sport coat today because it was over 80 degrees in the room.

We spent the morning combining lab and lecture for examination screening and the lumbar spine exam. The students have retained a lot of the material from the musculoskeletal course but we did have to work on increasing the depth of understanding. We had to review the psychomotor skills for reflexes, myotomes, dermatomes, and UMN screens. They were very attentive and focused on doing each skill perfect. I heard "Dr. Kyle" or "Teacher Teacher" about 75 times before lunch to get feedback on their technique. (I understand what Olivia means when she says she hears her name all day at school) They had great questions and our discussions about doing special tests and using examination findings to drive treatment were very informative. I think the way of thinking was challenged today but they seemed open to adding a new thought process into their learning.

Lunch was a pasta dish with a sardine red sauce. It was a very different flavor but I managed to eat 2 servings so it was not bad by any stretch.

After lunch our focus was on the objective examination for the entire lower extremity. Luckily most of this was taught a year ago, but having been a student myself I understand how easy it is to forget the material the first time. The emphasis today was improving the hands on skills with the range of motion, strength testing, and joint assessment. Working to make the assessment consistent and trying to "feel" end ranges and motions to help improve their ability to assess symptomatic patients.

The best part of the day was seeing the students growth. One student went from very shy with handling her partner to having full confidence. Another had a very tight grip with everything he did and by the end his partner said his hands were very comfortable and the student even felt the movement at the joint.

I cannot wait to build on the examination skills today using patient cases to help show them how impairments on the examination can drive treatment and how to grade treatment based on severity, irritability, nature, and stage. We will start to really put together the lecture content from Monday and the psychomotor skills from today.

After class, I spent some time with the Dean of the PT/OT department. She just returned to Haiti from America today. She goes back to her husband and family every 2 months. I really enjoyed finally putting a face to an email. The Dean and myself have been working together for 1.5 years via email. It was nice to sit down to learn about her life, her time in Haiti, development of this program, and plan for the future.

Our talk concluded and I was able to do a P90X video before the beef stew dinner.

Ready for a good night rest so we can make up for the lecture we did not get to at the end of the day and try to get back on schedule.

Teaching Day 1

I felt like a child on the first day of school. I woke up at 5:30 am ready to go. Sadly we did not start until 8 am so I did some personal reading and even reviewed some of my slides to make sure they were correct. After a traditional Haitian breakfast I made the walk over to the school to start the day.

Myself and the physiotherapy class:

At 7:55 am all of the students were in the commons of the school lined up. I learned that like in America they respect the flag before school starts. The entire school sang the anthem as the flag slowly ascended to the top. The passion in each students eyes and voices as they sang was so strong. I got chills on my arms as the song concluded and each student rushed into their classroom. I would expect this in grade school, but to see 20-40 year old adults doing this shows how much this country means to them.

I prepared 6 lectures for the day and knew it would be a long day for them. I started by getting to know the 7 students who are 4th year physiotherapy students. They have made it so far and I could tell from the first few minutes that they were all hard workers. After setting the objectives and going over the syllabus I started us with an icebreaker. I asked two very deep questions alongside the basics to help get to know them better. The first question was "what is your biggest fear" and the second was "if you won the lottery what are the first three things you would do". I was very impressed with their answers and learned a lot more about their culture and emphasis on community.

During the first half of the morning we focused on Clinical Reasoning and reviewing concepts from the foundational courses. They have retained a lot of the content which made the conversation much more interactive.

After lunch we worked on expanding hypothesis generation to improve creating differential diagnosis lists. I learned that as an education system, the Haitian students have very strong memorization skills as this is the main learning style they are taught. They struggle with more abstract thinking and application of knowledge. These students in the physio program have been working hard on these concepts and I can tell they are beginning to learn this skill and will improve it as the year continues.

I was very impressed with their conversation about clinical experiences. Many of the students expressed that the way of thinking they have been learning in this physiotherapy curriculum is very different than how clinicians in the country are practicing. They were excited to apply all of the knowledge they have learned prior to the rotation, but felt many of the therapists were not doing thorough assessments and still using very outdated treatment styles. It was so inspiring to see motivated therapists who want to improve the profession and challange the status quo of current practice. I hope that this week only adds wood to that fire.

After class I shot the basketball around on the outdoor court near the campus. One of the students saw me and we played a little one-on-one. Not playing ball in over a year and being in 90 degree heat left me exhausted by the end.

Chicken, rice, and fresh vegetables was a great end to the night.

I spent the night working on some of the lectures and self reflecting. I have a long way to go with my skills as an educator but after doing it for 8 hours straight I can say I love it!

Haiti Manual Therapy 2018: Travel Day and Exploration

Olivia and I enjoyed ourselves with great friends on Saturday as we watched 2 of our friends share vows in Annapolis, MD. Sadly the night was cut short and I headed to the airport for my trip to Haiti.

The flights went well and I landed in Haiti early afternoon. I forgot how nice it was to travel for 5 hours in the air and stay in the same time zone!

When I arrived I was greeted by a driver who helped grab my supplies. After we got my stuff to the car we waited for 5 other people. I learned on our drive to Leogane, Haiti. The group consists of 2 professors, 2 undergraduate students, and 1 master student. They are from the University of Notre Dame in the engineering field. This group is doing some great work to help with disaster response after storms and natural disasters. I learned so much from them and I am excited to learn more about their projects this week. I am always so humbled to realize how little I know about other fields of study and how much they can impact the world!

We arrived in Leogane at the school compound 2 hours later and were greeted by a very nice guest house and facility. After getting settled in, we had Pumpkin Soup for lunch and the students and I found the local beach. On the way we met a young man who educated us on the area. I really enjoyed the sights, sounds, and smells as we walked the streets of this small coastal town.

For dinner we had a traditional rice and beans, chicken, and vegetable meal. After dinner I spent the night looking over material for my first day of teaching.

This week I will be teaching the Advanced Manual Therapy course for the 4th year physiotherapy students. The class has 7 students who have made it this far in the program! The degree is through the Episcopal University of Haiti (UNEPH) and the Physiotherapy/Occupational Therapy degree programs are under the Faculte des Sciences Rehabilitation d'Leogane (FSRL).

It has been a great learning opportunity creating the content for this course. I have had so much help from the instructor who taught the Musculoskeletal course earlier in their education, AJ and Aaron from SU, and my colleague Adam from the UIC Manual Therapy Fellowship. I can't believe it has all come together and the week of teaching begins tomorrow!

Last Days (Clinic Day 9, 10, and Saturday)

Thursday and Friday:

As the week ends, I decided to sum up the days a little more quickly.

Thursday we arrived at the clinic and one of the physios was leading prayer. It was a great experience to pray alongside the patients to start the day. I wish I had seen it earlier and joined them every morning.

I mentored two students with one being a students second mentoring session and the second being one of the weaker ones of the trip. The first was George who was the head of the department with 30 years experience that I saw last week. He wanted to show he had learned from the first time and I could tell he was really trying to integrate the lessons from last week. He still needed a lot of guidance with the critical thinking but he was much more thorough with the questioning and trying to gather information. The focus today was to work on using objective impairments to treat. We worked on doing muscle testing to figure out which to treat and to assess joint mobility to figure out where to mobilize.  He said that he has always just treated based on what the x-ray showed or just where the patient was experiencing pain. I think that George will continue to grow so much during the residency year due his openness for change.

The second student was from a rural area of Kenya and he has been practicing 11 years.  He had trouble doing basic measurements and testing all of the simple things. I had to do a lot of teaching with him. The most troubling part of his session was that he filled out all of the objective examination  based on looking at the patient. He explained that he rarely tests and just guesses. I really tried to stress that this way of practicing medicine is unethical, not safe, and not helpful. After the session I spoke with residency staff and they were aware of weak he was, but said they changing his practice would help many patients because of where he works. They said the lower skilled therapists tend to work in the rural areas.  I loved that they are trying to not just make the good therapists better, but trying to improve the care as a whole.

At night our group went out for an Ethiopian meal with some of the residency staff. I was the only one from our group who had tasted this type of food so it was a great cultural experience for all. After we got to experience reggae night at a local bar. We had a great time.

On Friday we had a half day so we only had a few patients. Emily and I mentored together at first and then Lauren asked for some mentorship with a highly irritable case. At the beginning, he had severe pains and fear of movement. After some education, manual therapy to the abdominal muscles and obliques, and graded exposure to movement and dissipation he left with much less pain and was able to squat and even do a sit up!  It was a complete change and was so happy to end my clinical experience with this patient.

Our group presented gifts to the mentors and staff which they really enjoyed. The staff also presented us with gifts for our education and collaboration over the past two weeks. I was presented with an amazing handmade shirt. It was a perfect style for me and I could tell they picked out the fabric based on what I had been wearing all week and my personality. It was very thoughtful.

In the afternoon the students headed to the airport after our final reflection over lunch. All 6 of us really grew and learned a lot from this experience. It was hard to believe how many things we were able to do and accomplish in two weeks time.  For me, my low was that I was unable to treat more patients. With mentoring you are focused on teaching so it is more indirect patient care. It is also slower so we could not see as many patients as I would typically see I a day at home. But our focus was to impact beyond our time here, which brings me to my high which was the idea that we were able to provoke a change in thinking about patient care. Our influence as educators, if it resonates, will make a much larger impact on the country then the time we spent here. That is the best part of this work and experience, sustainability and progress!

(Some photos with our driver DJ Ken! He made our travel so much fun.)

At night, Emily and I went out with Martin for a few hours to enjoy our last time together. It was a great time!

Saturday:
Many people who stay at Grace House come for the week and travel on weeekends so it was a ghost town when we woke up for breakfast.
Emily and I packed and had our final meeting with Erastus and Martin.

We had a great trip, so much that we ran out of money on the last day which limited what we could do!  Luckily we had seen everything we wanted to except the Karen Blixen Museam. I did some research on her instead so at least I got to learn about her impact on Kenya.

We headed to the airport and prepared for our long flights home. I plan to use that time to reflect, work on my Haiti course lectures, and prepare for the next two weeks so I can hit the ground running on Monday.


Reflection:
Overall, this was such a great experience for myself as a therapist, global citizen, and humanitarian. My passion is to learn the world and make an impact as much as possible. Each journey has been teaching me more and more about myself and the world around me.  I feel so lucky to have opportunities like these and hope that everyone who read this blog was able to learn more.

Thanks for joining me on this journey!

-Kyle

Clinic Day 8 and Inservice

The midway day of the week was an eventful day. All of the mentees were late so we started by mentoring OMT therapists. Once the two mentees arrived, two others also showed up who were not on the schedule. This lead to a hectic morning.

I was happy to mentor Anthony who is a past OMT graduate. The SU students mentioned he liked to take some short cuts and use similar treatments for many patients.  His patient that we were seeing had been to therapy 11 times before this visit. Anthony explained his diagnosis and treatment plan.  I asked the patient his progress since starting therapy and he reported 30% improvement.  I asked Anthony if he thought he was on the right track or needed to reassess. He was open to reassessment.  I had Anthony look at objective impairments and check strength which is something he had not done prior to today. The patients symptoms occurred with lumbar extension.  With movement pattern changes and addressing impairments the patient was able to extend pain free post treatment. The emphasis with my mentorship with Anthony was to provide exercises, reflect constantly with each patient, and to reassess treatment effects to determine plan of care changes. 

When the first resident arrived we started the evaluation quickly to try to make up time.  This patient was post operative for a shoulder arthroscopic procedure in May. He had been in therapy but was still in pain, had limited with function, and limited range. After the subjective I asked the student if they noticed any yellow flags. He picked up on the fear avoidance to movement and hyper fixation on pain.  We worked on how to educate about tissue healing after surgery, emphasis on load to improve function, and use vs disuse. The patient appeared less tense and guarded after this education.

The objective portion of the exam worked on handling and technique for range of motion and joint mobility assessment. He learned quickly and by the end the patient said the handling was very close to my technique.

Exercise prescription was lacking in his education so I also put a strong emphasis on teaching exercises, technique, and dosing to help improve his concept of how and why to give exercises.

The second student has been strong so far in residency and choose to pick a complicated patient to challenge herself. I admired her desire and was excited for the session.The patient reported with low back, leg, neck, and shoulder pain. She has had 18 surgeries in the past 8 years along her neck, lumbar spine, shoulder, and abdomen. She would be what we call a complicated patient at home. I could tell the student was overwhelmed, so I jumped in a little to try to help her out.  I worked on trying to address function and patient beliefs to help drive the session. Her biggest aggravating factor was standing in place and her relieving factor was walking. This did not make sense to the student so I had to act out and think about this to come to a hypothesis of what could be driving symptoms. She began with 9/10 standing pain and burning down her leg after 3 minutes of standing. After addressing the abdominal region with some manual therapy and motor control training in supine and standing we reassessed her standing.  She was able to stand with 1/10 pain and no burning symptoms down her leg after over 18 minutes of standing.  The big take home point for this complicated patient was to listen to her story, educate and give hope, find impairments, and work on function. The case could not have gone any better and I was so happy to have had this teaching moment with her.

With such a busy morning, I worked way past lunch so after a short time to clear my mind, I started to set up for my inservice presentation. My topic was clinical reasoning and evidence based practice. This lecture is an expansion of a lecture I gave in Ghana a few years ago and their national physiotherapy conference. The topic and style of presentation challenged everyone’s thinking and wrapped up the large emphasis I had been placing in mentorship all week. I was worried how it would be received, but I had 3 questions during the talk and over 45 minutes of discussion after I was finished.  I loved to see they took the challenge and were thinking of ways to improve their practice.

After a busy day we went out to dinner with the head of the therapy department for goat.  We wanted to try something new, but he had decided we would do this meal again and so it was the final say. At the meal his friend, Wilson, presented us with tea from his company to bring back and share with our American friends. It was such a nice gesture and we were very grateful.