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Improvise & adapt Therapist teaches Nicaraguans how to build simple adaptive devices

Healthcare workers participate in a physical therapy workshop in Tipitapa, Nicaragua.

Last summer, Andrew Suseno, PT, DPT, CLMA, CSCS, traveled to Nicaragua in partnership with the Dos Pueblos New York-Tipitapa Sister City Project, a nonprofit group that works to promote community development in the country through human rights, education, health promotion and other areas. He spent 3 weeks in Tipitapa, a sprawling urban and rural community of more than 100,000 people, where he organized a series of workshops on rehabilitation skills, and on building adaptive equipment from cardboard for children with disabilities. Back in New York, Suseno works as a physical therapist at Aspire Health and Wellness Center in Manhattan and serves as an adviser with Adaptive Design Association Inc. Recently, he talked with Today in PT about his volunteer work in Tipitapa and his plans for the project there.
Q: What were some of the roadblocks you encountered?
A: The conceptions of what a physical therapist is are different there. In Tipitapa, documentation, evaluation and assessment weren’t associated with physical therapy — those things were associated with a doctor. Doctors prescribe the exercises PTs follow through with. So it was tricky. Because I was a DPT, I was introduced as, and called, “doctor.” It gave me a little more respect.
In the first workshop, I handed out written papers asking people to fill out about their children’s eating and sleeping habits, and measurements [for the equipment]. Within two hours, I realized a lot of them don’t know how to read. A lot of them can’t add or use a tape measure. It wasn’t just translating across languages, it was translating across education levels. By the third or fourth workshop, I was getting it. We needed to show pictures. It’s not dumbing anything down, it’s just using a medium people can understand and apply.
Q: What was most rewarding?
A: Teaching families or physical therapists or teachers how to work with cardboard and build adaptive equipment out of cardboard was so concrete. I could feel their excitement as they saw how it could be applicable to children in their communities. It was also through the equipment that people at the Tipitapa hospital began to open their eyes and say we can actually meet the needs of all these rural communities because cardboard is free. It is something we can afford.
Q: What kind of followup have you provided?
A: That has been a bit of a roadblock. It was wonderful that we put on four workshops and reached 70 people from the communities, and left with a new relationship with the hospital [in Tipitapa] and with Partners of the Americas [another international organization that is helping support the project]. We hoped to be able to communicate in some way about progress, but the plan fell through because we didn’t culturally prepare. When community members we trained in the workshops started working with families, they were questioned about their credentials. I had planned to keep in touch with them [online], but it is difficult for some people to get to a cyber cafe and it costs money. But some people have continued to build equipment out of cardboard. The Tipitapa hospital is working with Dos Pueblos and me about creating a workshop space where people can go to build equipment. I hope that will happen and there will be increased dialogue between the health professionals and people in the rural communities. I keep in touch with the community advocate who has connections with all the community leaders, and I’m planning to go back, probably in the summer. I’m going to focus on getting the adaptive design workshop at the hospital under way, and find a couple of leaders in the community who can take charge and run with things when I’m not there.
Q: What are the most valuable lessons you learned?
A: I learned that when people see you as a doctor, they expect you to be able to see and treat everything. Over there, I felt extremely responsible for those I was treating because I knew they were not seeing any other health professionals, whereas here I figured somebody else might be checking up on them. I think the level of accountability shifted in my mind. Maybe this comes with more experience, but I have realized that when patients tell me things, I have to treat it as if I’m the only person hearing it, no matter where I am.
Q: Are there many opportunities for PTs to make a difference?
A: I think it’s important for PTs to do this work. But also I think it’s important to leave people with something they can apply once you are not there. People trust a sustained relationship and connection more than somebody who just rides in and rides out. You can have the best PT skills, but if you don’t earn people’s trust and develop relationships, as soon as you leave, they are not going to follow through. Children with disabilities often are hidden. They are kept out of schools, they are kept in back rooms at home, and it’s asking a lot of their families to change their perspective. They’ll say ‘yes, yes, yes’ while you are there, but unless we can truly listen to what their concerns are, that ‘yes, yes, yes’ isn’t going to transfer into something that lasts.
Q: What is your advice for other PTs who want to become involved in overseas pro bono work?
A: I would advise people to understand what kind of commitment and connections they want to make. If you are going for a week or a weekend, there are organizations that take PTs abroad and already have all the necessary community connections. But if you are going to be forging new relationships or making a partnership with organizations already there, then preparations need to occur beyond the trip itself. You need to prepare for good communication, so everybody is on the same page and can set goals together of how your visit is one step of many for making the project sustainable.
@Bio end:Cathryn Domrose is a staff writer.
@Editor’s note/to comment:Share your thoughts: [email protected]

Adaptive design and cardboard construction in Tipitapa Photos courtesy of Andrew Suseno, PT

By | 2021-05-07T09:30:53-04:00 July 19th, 2013|Categories: Nursing Education, Nursing News|0 Comments

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