Guest Post: Dr. Kyle Feldman PT, DPT

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!

 

—If you would like to follow Kyle’s Blog while in Haiti go to:  https://mobilizetheworldpt.blogspot.com/2018/10/travel-day-and-exploration.html

New students begin on October 5th 2018

The new students are here!  Even though classes have been in session since the beginning of September for the second, third, and fourth years, the students of the first year just arrived, on the 5th of October.

We have 14 students, and all have good reasons for coming.  For instance, one is already a rehabilitation technician, one has a brother in the US who is an occupational therapist,  and one is the daughter of a rehab technician from St. Vincent’s whom we knew years ago.  Altogether there are five students with sponsors from the US, and the others have support from their families.   This is a strong group!  The photo shows the brief ceremony of signing in, in the official FSRL book. 1ere Annee 2018 (1er jour)

 

We welcome them into the first year.  During the coming year they will take most of their classes with the Nursing students of FSIL.

Meanwhile, during that same Friday when the first years signed in, the rest of the FSRL students celebrated the third birthday of FSRL!  The FSRL birthday party is to celebrate  the 5th of October in 2015 , when the first students began their studies.  Those students are now in the fourth year, and planning to graduate in Dec. of 2019.

The celebration started wtih a prayer service in the auditorium.  The students then spent the morning working hard to prepare and serve a big lunch to the whole school.  And after lunch the students of FSRL went to the beach!  At La Galant, in Grand Gôave, we swam and danced and ate lots of cake.  It is wonderful to have three years of history  to celebrate, by now !  And we are finally a full university program, with all four years of classes present.  Hallelujah!

 

NEW new beginnings!

What a year! 2017-2018, all wrapped up!

What a summer!  I’ve been home for most of August in Montana and California!

O'Flynn family in Penngrove CA-Aug 4 2018

Aidan, Chase, Donnel, and Janet at Chase’s home, Dhammadharini Monastery in Penngrove, California

It’s Sunday afternoon, 26th August.  I’m in the plane on the way back to Port-au-Prince, ready to start the 2018-2019 academic year on Monday, September 10th.  The nursing school,

FSIL, does a lot of planning during August, so by returning for the last week of August I will be able to join in some of that planning.

The 2017-2018 year finished in July with final exams for the freshmen.  The clinical formation for the Sophomores and juniors continued into early August.

FRESHMAN YEAR

We lost three members of the freshman Class due to their failure in more than 2 courses: instead of 13 students, we now have 10.  These programs are not easy, and guidelines are strict.  The academic guidelines are requirements by MSPP, the Ministry of Health, for nursing programs. A student must pass all but two classes, out of more than 20 completed in freshman year.

The academic rules, even though they are harsh, are a protection against a big investment of time and money in an education that then cannot be completed by a degree.  In order to graduate, each student must design and execute, and then defend a research project that uses all the skills gained from FSRL.  If a student who cannot pass the earlier courses is promoted to fourth year, it could happen that after four and half years of effort that student would be unable to graduate with the bachelor’s degree: which would be a catastrophe!

The students who are not be going on will be missed. I dearly hope that another path to employment will open up for them.

SOPHOMORES & JUNIORS

Our students went in groups of two to four to a variety of outpatient rehabilitation clinics, some far away.  The sites, which we appreciate so very much, were

  • FONHARE (Fondation Haitienne de Réhabilitation) with Dr Ivens Louius and Dr Michael Falcon in Ouanaminthe in the north,
  • FONTEN (Fondation Tous Ensemble) with Mme Consuelo Alzamora in Les Cayes in the south,
  • Respiré Haiti with Mme Ashley Kahila in Léogâne,
  • and Healing Hands for Haiti with Mr Anani and Mr Paulin in Bourdon, part of Port-au-Prince.

Responses of supervisors and students were positive: our students felt well prepared, and the supervisors appreciated their preparation and their initiative as well.

Michaud clin ed-July 2018

Exercise to reduce pain and increase flexibility in the upper back, at Healing Hands for Haiti.  Our student is enjoying the patient’s relief!

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FSRL student providing manipulation for evaluation and for relief of symptoms.

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FSRL students learning how to make and modify orthotics

One situation that started off as a concern expressed by the students turned into a great learning opportunity.

At one of the sites, two PT students expressed surprise to me because their newly acquired skills in manual therapy for orthopedics (that is, hands-on physical evaluation followed by hands-on manipulation) were not being done at their clinic.  Then during the students’ mid-term evaluation, they received the feedback from their supervisor that they were at fault themselves for not teaching their colleagues the techniques they knew!

That is a sign of a strong clinical program, a good health care facility,  when practitioners are open to learning.   One incentive for clinics to take students has always been that the practitioners  learn new approaches when students come in fresh from classes:  the other PTs and rehab techs wanted to learn what they had seen our students doing!

The experience will be repeated again and again as our students go out into the working world.   That happens in all countries, but especially I think it will happen in Haiti where practitioners have had to struggle so much to get their education, and where continuing education is hard to come by.  Our new graduates will need to be nurtured with continuing ed courses, and they  will also need to be always teaching.

EXCITEMENT ABOUT THE NEW YEAR

Even though few students are on campus, there is an excitement in the air for the new year.  FSIL has painted many walls, done a thorough cleaning (again) of the building, and revised and reprinted the very important Student Manual and Dormitory Manual.  For FSRL, we are making phone calls and sending emails to fill in missing slots in our teaching rotation (hey!  Maybe YOU want to come and teach!) .  We’re considering how to stretch our dorm space, how to reinforce the rules and customs of FSIL that are also required of FSRL, how to hold a “Saturday School” for a handful of students who failed just one or two classes.  We are looking forward to the return of Dr. Rachel Woodson, PT from Arkansas, who will help us with faculty coordination, some teaching, and some clinical supervision.  This should be the year when our students begin a weekly fieldwork visit to Hôpital Ste Croix, the local Episcopal hospital that has been asking us all along to provide a rehab service.  WE FINALLY HAVE FOURTH YEARS!  SENIORS!

Our 4th year students are ready!  We will ask Rachel to accompany them on their hospital visits as often as possible, and we hope to have another PT, a Haitian practitioner, to help us as well.

TWO “first days”; TWO BEGINNINGS

This campus has TWO beginnings.  In September the returning students begin (Sept. 10) and on October 1 the new freshmen begin.  The first-year student process will be described in a later blog – stay tuned!

Guest post from PT Rachel Woodson: A remarkable moment for our PT and OT students and the student nurses of FSIL!

Rachel Woodson is a physical therapist and missionary from Arkansas.  She has been helping us a LOT by supervising the PT students on “Stage” or fieldwork, at the Hopital Ste Croix.  Ste Croix has never had rehabilitation services, in its 40 years.
Thank you Rachel for permission to share this!

Tuesday, May 22, 2018

Yo Kapab (they can)

Today was a special day, an amazing day. We are taking 8 students (3rd year PT and OT students) to the local “public” hospital this week and next. We have primarily worked with 4 patients during these two days. One patient is an older gentleman, we will call him Jean, whom suffered a gunshot wound. Following the students’ initial evaluation the patient was found to have no movement below the waist and post op abdominal surgery. The surgeon came in shortly after and kindly spoke with us about the patient. When he and I were talking he said to me “I don’t think he needs to be here (ortho floor) anymore, I think he should transfer to neuro bc maybe he has a spinal cord injury from the gunshot but we don’t know.” Long story short we went in and sat the patient as the edge of the bed for the first time after his surgery 10 days ago and he was a little dizzy and VERY weak. He had not moved fromlaying on his back, however the nurses had done a good job of preventing pressure sores/ulcers.

When we came in the next morning we were informed that the patient was being discharged. The family had not been taught ANYTHING. No positioning, no transfers, no catheter changes, no infection precautions. NOTHING. So we began to work with the students on educating the family and getting the family involved in transfers and planned to teach the family to transfer Jean to a wheelchair (even though they did not have the money to purchase one) and some other basic spinal cord injury education. We started to discuss it and they were talking about how surgeons get tunnel visioned on their one issue and will sometimes discharge patients not understanding everything. I voiced what he had said to me and then the ball started to roll….

The nurses called the doctor and he confirmed that he did feel he needed to be transferred to the neuro unit but that the doctor on call would have to make that decision. When the doctor arrived he “conferenced” with one of our PT students and a nursing student that had been fantastic in caring for the patient as well (the photo above). They advocated for the patient and the doctor AGREED that the patient should stay on the neuro unit. They also talked to the director and he interviewed the family to determine if they needed a wheelchair without paying. The option also came up for him to go to an inpatient rehab center, which is still in progress as to if that will happen.

I was amazed and started to tear up thinking how these students are changing this country starting with that man. They are doing it respectfully and dignified. They are doing it by working TOGETHER as a healthcare TEAM. They are doing it because they care about their patients. It is a long road ahead, but THEY ARE DOING IT!!! I was so proud to be part of FSRL/FSIL today. That man would have likely laid in a bed at his home, never moving, and had no quality of life if these students (PT/OT/nursing) were not there. He would have likely died in the next 3-6 months due to wound infection, pressure sores, pneumonia, or some other related illness secondary to his apparent spinal cord injury…. But now he will have some time and physical/occupational therapy to live a better quality and more dignified life. This profession of physical therapy that I get to call a job will always give me pride because I get to watch peoples lives change. Because I beleive that quality of life is as important to a person as actual life.

Today was refreshing and I am so excited to see rehab professions become a more common part of the healthcare team as it demonstrates progress in Haiti from pure survival to giving quality of life to the patient and family through respect, dignity, and improving independence.

Live Foolishly
Rachel

Rara, and how the whole evening made me feel so valued! How unexpected, for this particular event!

I am sure you are wondering how the rara evening turned out!

It was last Sunday, just HAPPENED  to be Easter Sunday. Actually, it is always a big rara weekend on Good Friday, Holy Saturday, and Easter Sunday.  The FSRL students and I were invited to join FSIL nursing students on a reviewing stand right at the beginning of the parade route, where the bands started off on their musical march.  We were there at dusk, but the parades were destined to go all night and into the morning light.

rara 13-daylight-FSILstudents on rev stand

FSIL nursing students (and a couple of Rehab students too) peering over the rail of the reviewing stand, at the rara parades below.

One of the Americans staying in the Guest House during Holy Week said that having all the families outside in the streets, and flags, and glow sticks, made her feel just like on the Fourth of July back home, and that is a good way to express the mood!

Here is a photo of the staging area in the street as night fell:rara 16 - twilight to night crowd

As you can see in the earlier photo, the prime viewing spots at the rail were taken!  I climbed on a chair behind this row and could see a lot.  But after an hour or so, I was invited (by gestures, since the sound was overwhelming and conversation was nil) to squeeze right into the middle and get the best-ever view.  Here’s a short video clip (1 seconds) of the announcement for a band, and the start up of the bluesy rhythm.  I have been told that Haitian music is a prominent part of the background for New Orleans music, and it certainly did have that sound.

 

But still, after four hours of this (by 10:30 or 11 pm), I was flagging and started wondering how on earth to get across town in all the crush of humanity.  There was a van available, and there was  a driver (a wonderful nursing student, Jephté, who also drives ambulances), but it was just going to be impossible to move that van even an inch in the crowd.

So, as I was thinking this and wishing for a helicopter, one of the nursing faculty spoke to one of the guys, and almost immediately four young men, three of them our rehab students, came up to me and (over the music and crowd noise) told me they would walk me home.

rara 4- night-3 gallant guys

Selfie with three gallant guys, Rehab students at rara!

I was to stay in the middle, and the four guys on the four corners, and we would just go right through the crowd all the way back to campus, about one mile away.

It was great! With two in front and two behind, striding purposefully, hands on shoulders when needed so not to be separated, we struck out through the crowd.  As we were SO close (inches away) to all the other partiers, I did get some surprised double-takes – but by the time someone could wonder why an American was there in the crowd, we were already gone.  When the crowd began to open up a little, we hit a good walking stride and covered the distance back to campus in good time.  It was cool.  It was like being a Jet, in West Side Story.  Me and the guys, cool and confident, walking fast, safe and sound, all the way home.   They were talking and joking and making sure I didn’t fall into any potholes in the dark – all good.

I hope you can feel that too, that sense of being valued and protected.  In spite of any ambiguities about how our two countries get along, the people with whom we share this audacious project to bring rehabilitation professional education to Haiti are on our side!  We have allies, from the patients to the students to the faculty  to the university administrators to the Episcopal clergy in the Diocese.  It is good to see, concretely, that this is working!  We DO have a team!

Happy Easter (all seven weeks of Easter) to you all!

 

A PROVOKING message, from a Maundy Thursday and Good Friday point of view

Last evening, at 5:45 pm, I participated in the lovely, simple, powerful service of Maundy Thursday.  Only 14 people were there, including clergy.  We sat in an oval arrangement, with the holy table right there at one end.  Père Sonley talked about the significance of the intimacy between Jesus and his closest friends, and that that is the same soul-friendship that Jesus offers each of us with himself.  In the same way he encourages deep friendship, at the deepest level of our souls, between all of us here and now.  Come let us deepen our lives together!

Today at mid-day I will go to Église Ste. Croix for the Liturgy of Good Friday.

Here is a lovely passage from the letter to the Hebrews, from the readings designated for Good Friday.   (I am reading them in English this morning, with the intention of understanding the Kreyol reading better, when I go today.)

Let us hold fast to the confession of our hope without wavering, for he who has promised is faithful. And let us consider how to provoke one another to love and good deeds.      Hebrews 10: 23-24

I am by this inspired to write a message that is “provoking”!    But, as the author of Hebrews says, “Let us consider how!”

What is the situation right now today in our lives?

Each of us has something heavy on our hearts, I am sure, this Good Friday.  And each of us is in some way looking for the Kingdom of Heaven, where the severe limits of this life don’t apply.  In the Kingdom, there is Enough for All.  (It might be, Enough health and wellbeing.  It might be, Enough love and forgiveness.  It might be, Enough financial resources.  It might be, Enough peace between warring factions.  It is a longing for there to be Enough – for there to be more than Enough – for there to be ABUNDANCE of all kinds!)

The plight and the promise at FSRL: the Faculté des Sciences de Réhabilitation de Léogâne: two academic programs: one in Occupational Therapy and the other in Physical Therapy

I am moved to tell you, as readers of this letter, that we have had too little income to meet our expenses at FSRL for two or three months by now.  We have had some income, allowing us to  pay our staff, which is the priority.  However, we have had to postpone payment of our other big bills, for example for rent for our classroom and office space, and for lodging for our volunteers.  We owe payments to the Episcopal University of Haiti (UNEPH) and to the Episcopal Diocese.  And, this month for the first time, we don’t have enough money to pay a full month’s salary to all our staff members.

HOW do we think about this?

Considering HOW to engage and provoke support is complicated!  That is because there are so many kinds of ears listening at the same time.

  1. Some people might honestly be dismayed that an American OT and her husband have launched a whole team of Americans and Canadians into this project without having first established the financial basis of it. There is some truth to that criticism.  But I can say that there is a psalm that addresses that, and it’s in today’s lectionary too :  “Let not those who hope in you be put to shame through me, O Lord of Hosts.” (Psalm 69, verse 7)

Once Mother Theresa had a burden on her heart for some children who lived in destitution and hunger immediately outside the gate of a rich man, a Muslim.  She went to the man, held out her hand, and asked him to do something for them.  He spat into her hand.  She wiped off the spit, then said, “That was for me.  And now for the children,” and held out her hand again.  He was so moved that he immediately gave what she asked for them.

Mother Theresa – always surprising, because she lived by different rules than the rest of us!

I am often, possibly always, aware of at least one part of the equation:  that I personally am in over my head with this project.  But that does not change in any way the Area of Moral Clarity, providing appropriate Haitian rehabilitation for Haitian people in desperate need.  The need and the promise are real.

  1. Some people have already given to a sacrificial point. People have turned over their inheritances, opened their retirement savings, committed to a monthly gift, gone out on a limb to support these academic programs before we even had students.  You know who you are.  I hope that you will see this “provoking appeal” as an opportunity to engage more fellow travelers!
  2. Most of us have many many claims already on our finances. We all need to pay rent or mortgage, buy food for the family, pay for school, pay for healthcare, and on top of that we  have other charities we support.  I respect that a lot.  The Kingdom, in its abundance, relies on thousands of different perspectives on where to give!  Maybe your gifts are already doing good work, and if so then God bless that work too!
  3. Some of us have NO income that is not already allocated to sustain life. That is the truth.  And we all have to trust that in that case God’s generosity will come around to help us too, to give us groceries and pay for heat!!

 

But if after considering ALL this you have room to help, please help.

 

The Haitian students are the key.  By now, the third-year students (7 PT and 3 OT), have mastered many aspects of the specific needs and the path forward for Haitians with disabling conditions.

Michaud's perfect score on test

Jean Laurent with a perfect paper, PLUS a bonus point for Functional Neurology! 101/100

The third-year students are pushing us to let them start providing care NOW.  They are asking for more clinical experiences, right away this week, without waiting to graduate. Some have come to ask permission to go as a group to a health education or health fair event at their churches.  Some are planning a collaboration with the Association of the Handicapped of Léogâne (where the earthquake was strongest, right here, leaving many amputees and persons with traumatic brain injury).

There are patients who are more than ready too: people coming to our gates, carrying children, or helping a family member to limp along, asking, “Don’t you have therapy here?  Can we come in?”

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Third-year student Amendocia on fieldwork in January at Healing Hands for Haiti.

 

What can we do?  What can you do?  I think the starting place is to know what the needs are, and what is the promise for people who are hurting, if those needs are met.

Blessings on your Good Friday, and for all of us, blessings on Easter too!

 

Janet

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A surprise, a TREAT!

Ha ha!  I am still chuckling about a nice surprise that I will get to participate in on Easter Sunday.   I think it will start at about 6 pm on Sunday evening.

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rara in the daytime

 

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rara in the night-time

I was just explaining in this blog the phenomenon of rara music, which sounds like tuba bands or brass bands, New Orleans-style.  Yesterday, for the first time, I found out I’ll have an opportunity to be in the middle of a day of rara, without any danger at all.

The nursing students here at FSIL offered a first-aid stand right downtown last year, near the bleachers built for the audience for the biggest rara parade of all, on Easter Sunday.      The FSRL students and I have been invited to participate, offering our therapy know-how to wrap a twisted ankle, for instance.  I hope we can find a source for ice and Baggies!

Most of the students have already gone home for the holidays, so some of them are quite far away – Port a Piment to the west, and Croix de Bouquets to the east- and will not be able to participate.  The two who live in Léogâne will probably come though.

So the reason I’m chuckling is that at lunch with the staff today, there was a lot of eyebrow-raising and laughing about the day we will have together out at the rara parades.  It reminded me of the kind of giggling you might hear when you and your nurse friends are going out to do first aid for a Harley-Davidson rally.  These guys putting on the rara are kind of “bad boys”, but the nurses are prepared to provide first aid no matter what. They predict that people drinking clairin, un-aged rum, for hours in the heat could cause some emergency needs .  That, and swollen lips from hours of playing the horn. (I realize that that the drinking part is way DIFFERENT from the Harley-Davidson rally, where in fact the motorcycle drivers are responsible about drinking!  But some of them do lean too much on the horn.)

I am glad to be able to see and hear these parades.  I may not be able to take photos, but here already are two photos from the internet so you can get an idea.  And you can find YouTube videos of rara, to be able to hear the sound!