Learning Experience – OT, PT Students Spend Their Spring Break in the Field

For most college students, that third week in March is a time to pack their bathing suits and flip-flops and head to tropical spots for a bit of much-needed R&R, where they soak up sun, sights, local cuisine, and entertainment.

Enjoying spring break in warmer climes is, of course, a college tradition.

At Springfield College, though, some students decided to add medical scrubs to their packing lists, along with their beach blankets and sunblock. A dozen graduate students in the college’s physical- and occupational-therapy programs spent March 13-17 in Haiti and Trinidad and Tobago, honing their clinical skills as they worked with patients in need of services.

The programs are part of the college’s global health initiative, which looks at worldwide health issues and the contrast in the provision of healthcare and rehabilitative services in the U.S. and other countries.

Dawn Roberts, an associate professor of Physical Therapy at Springfield College, led the trip to Haiti, where, she says, healthcare resources are much more limited than in the U.S. The Republic of Haiti has a population of about 10.6 million, and is one of the poorest countries in the world. It is plagued by high unemployment, poverty, food scarcity, and inadequate infrastructure.

For the third year, Springfield College students worked alongside staff at the Haitian Foundation of Rehabilitation (FONHARE) in the town of Ouanaminthe. The grass-roots, nonprofit clinic provides integrated physical and cognitive rehabilitation to residents of 13 towns on the northeast side of Haiti. The group was there at the invitation of Ivens Louius, FONHARE’s founder and director and a trained physical and occupational therapist, with whom the college has a long-standing relationship.

In Haiti, the students offered both physical and occupational therapy services. Physical therapy utilizes mechanical force and movements to improve mobility and function, while occupational therapy focuses on developing or improving activities of daily living, adapting the environment or modifying tasks as needed.

“A lot of people in Haiti can’t afford medication or diagnostic testing, or even medical care and treatment,” Roberts told HCN, noting that 83{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the services provided by FONHARE are free. “We serviced anyone with rehabilitative needs; we saw individuals with chronic stroke, orthopedic injuries, and a lot of children with developmental disabilities.”

The students said they were surprised and challenged by the lack of resources at the clinic, and learned from local professionals how to fashion homemade or jerry-rigged equipment. For example, Anna Lovotti, a second-year doctoral student in physical therapy, used what was at hand, constructing a foot orthotic out of duct tape and cardboard for a 23-year-old man with ankle osteoarthritis.

“Since the resources are limited, we tried to be creative,” said Heather Luciani, a second-year student in the college’s master’s-degree program in occupational therapy, who worked mainly with stroke patients, including those with contractures (shortening and hardening of muscles, tendons, or other tissue) or hypertonia (increased rigidity, tension, and spasticity of the muscles).

“We did a lot of loosening them up first, so we’d start with heat and then do range of motion, trying to help them extend their elbows or their fingers,” she went on. “We’re trying to consider what people do in their daily lives, like reaching the cabinets. If you have contractures, you can’t do that.”

Into the Unknown

Before the trips, Roberts said, the students learned about the politics, economy, and healthcare in the countries they were visiting, and familiarized themselves with these nations’ histories and geography.

Nevertheless, Luciani said, she had difficulty imagining what she would be walking into.

“I had no preconceived notion of what the environment was going to be like, what it would be like in the clinic,” she said. “This was my first true hands-on experience, running the therapy.”

Roberts agreed that the experience was eye-opening, and provided some much-needed experiential-learning opportunities. “Nothing beats having your feet on the ground,” she noted.

The students visiting Haiti stayed in a dormitory on the town’s one paved road, in an area marked by cement buildings, some abandoned, and colorful shanties built up the mountainside. After a standard Haitian breakfast of coffee and a traditional, grainy white bread or labouyi (porridge), the students donned their scrubs and walked the quarter-mile to the clinic, where they saw patients throughout the day, working with the help of a prepared vocabulary list and a translator who spoke English and Haitian Creole, the predominant language.

“The patients worked very hard,” Lovotti said. Their mindset was to keep going and push through, which was nice to see. A lot of people here dread physical therapy, while, there, it was the highlight of their day.”

Meanwhile, associate professor Kim Nowakowski led five physical-therapy students to Trinidad and Tobago, where they helped conduct a national falls-prevention program based on a needs assessment conducted by the Total Rehabilitation Centre Limited and the Physiotherapy Assoc. of Trinidad and Tobago (PATT), an organization that aims to improve health and wellness in that nation of 1.3 million. Carla Rauseo, a 2004 alumna of the physical-therapy program at Springfield College and a member of PATT, initiated the collaboration.

The Republic of Trinidad and Tobago is a two-island nation situated about seven miles off the northern coast of Venezuela. In contrast to Haiti, it is the third-richest country in the Americas (after the U.S. and Canada), but still faces relative challenges, like an inadequate infrastructure, which makes travel difficult for patients.

“We had individuals who were walking two miles,” said Nowakowski. “They were tired by the time they got there.”

The country’s Ministry of Health provided buses to transport some of them to screening sites, she added. “That was really nice, because they wouldn’t have had access otherwise.”

Although English is the official language in Trinidad and Tobago, people typically speak Trinidadian and Tobagonian Creole. Nevertheless, students say, they were able to function without a translator.

“They have a pretty interesting accent,” said Abby Mulligan, a second-year doctoral student in physical therapy. “Sometimes that was difficult, but they had trouble understanding us more than we had understanding them.”

The students and Nowakowski shared an apartment in Glencoe, Trinidad, and immersed themselves in the culture, eating local foods, like roti (fried dough with beef or chicken and chickpeas in a soupy mixture) and fried shark. “It was all really good,” Mulligan said.

They traveled to three communities on the island and to one town on Tobago, about a 20-minute flight away. At each stop, they assessed individuals for their risk of falling. Over the course of the week, they saw 375 adults ages 60 and up, including some with hypertension, diabetes, and obesity. The work was done in collaboration with local professionals, who offered educational presentations.

“This program was more about health and wellness than actual treatment,” Nowakowski said.

The students did stand-and-sit tests, in which those receiving services are asked to sit on the floor, and then to rise using the minimum support needed, as well as balance tests (standing on one foot or with one foot in front of the other). Each participant received a risk assessment, or ‘report card,’ as well as personal education about possible interventions, including physical therapy.

“One of the cool things we learned before we left was that some of the participants had already been to their physical therapists with their report cards,” Mulligan said. “That was awesome, to know we’re actually making an impact.”

In both programs, the students worked with local professionals, updating them on the most current evidence-based practice.

“They don’t always have access to the latest journals and information, so we’re sharing with them techniques our students have learned in their clinical experiences in the United States,” Roberts said. “Every year, I come back and see them doing things that they learned from us. It’s a sustainable continuing-education process.”

A Healing Vacation

Participating students each pay $1,500 to cover the cost of travel and room and board. The group received about $1,100 from Springfield College, and the students also did some fund-raising to cover incidental costs, like border-crossing fees and visas.

Roberts says the additional expense can be prohibitive for some students.

“The cost limits students who probably would thrive and gain something valuable from this trip, but, financially, it’s not feasible; it’s something we struggle with,” Roberts said. “Our long-term goal would be to have institutional funding, some sort of sustainable budgetary instructional funding, and we’re not quite there.”

This year, a scholarship was offered by Live Every Day, a private physical therapy clinic in Connecticut, founded by Matt Calendrillo, an alumnus of Springfield College, and his brother, Anthony.

“We started a Giving Back Scholarship to support the efforts of the physical therapy department at Springfield College and their global health initiative,” said Matt Calendrillo. They awarded the scholarship to Lovotti, who this year made her second trip to Haiti with the program. Last year, she said, she took out a personal loan to finance the trip.

“We selected Anna Lovotti … to take away the burden of travel and expense and allow her to focus solely on the good work and need that awaited,” Calendrillo went on. “It is our anticipation in doing so that she will continue to fight health disparities, and spread the word of global healthcare need as a compassionate healthcare provider, powerful humanitarian, and unselfish community leader.”

With that, he effectively summed up just what this quite unique spring-break opportunity — not a vacation — is all about.