Well, I did it!!! I just finished one of the main things that was the main reason I went on this big trip in the first place... "official" volunteering! All this volunteering I did beforehand were independent, but for this, I went through an organization, Health Volunteers Oversees (HVO or hvousa.org).
I liked them because you didn't have to pay to volunteer (hmph), as many organizations make you do, and I liked the mission of improving health care by education. HVO had several locations specific to Physical Therapy: Peru, Vietnam, India. I chose India because from travelling here a couple of years ago I was familiar with it and also liked it and didn't mind coming back. I also was impressed with the location being at the Christian Medical College, CMC, in Vellore because this is actually one of the best hospitals in ALL over India. People literally come from all over to get care here, so impressive!
The Outpatient Department (OPD).
The "assignment" was 3 weeks. In those 3-weeks I was to teach and give lectures daily from 1-1.5 hours, and then also spend time in the clinic. So my day began at 7:30 am and I would typically get home around 7 or 8pm. My lectures were from 5-6:30, but often I stayed later for questions, and as they are in the clinic from 8:30am-5:00pm. But first, always starting with a morning prayer:
Most of my time during the day was in the clinic or spent preparing for that days lecture. LOOOOOOOOOOOOONG days, I tell ya! I was often exhausted at the end of the day and I never realized how hard teaching is! It wasn't just the prep work, which was a lot, but it was the details, concentrating on speaking slowly, trying to understand if they understand, adapting to the different knowledge/levels.
My class consisted of approximately 40 students, and when we had our "lab" time (practical), it was pretty hard with just me to go around and try to teach, demonstrate, or answer questions. I actually became a dictator a couple of times in that I used a whistle I got for travelling (safety and it has a compass on it!) to either get their attention (they are ALL under 28 y/o, hence distracted) or to move onto a different demonstration. But yes, this was very very challenging. Where are TA's when you need them? :-)
I found the staff here very very very very smart! They are excellently trained in "theory," i.e. very "book smart." A little out-of-date with evidence-based stuff, i.e. they have a whole "electrotherapy" department whereas we are trying to ween away from modalities in the States...
But overall, I was impressed by their knowledge and some even caught me off guard when they started talking about super technical things like force vectors and momentum arm. Uhh..... I haven't even thought about that since grad school. Having said that, they often had challenges with comprehensive and didactic thinking. I learned when I got here that they were definitely more interested in the hands-on stuff, like mobilizations, manual therapy.
Class before a 'theory' lecture. There was a screen for power points behind me...
...And class for the practical sessions. There are 9 PT departments so this was an opportunity for them to learn, but more importantly, see their friends :-) ha ha. For the lab sessions, I would be placed at a plinth in front and either have an actual patient or a staff member demonstrate.
So I really had to work hard to revamp a lot of things I prepared to make it more practical as well as to stress more practical exercise interventions for their patient population (a LOT of chronic issues).
Teaching was okay, I did find that the more interactive classes were both more interesting (and fun!) for myself and the staff. But I especially LOOOOOOOOOOVED the time I spent in the clinic. It was a good chance to get to know the staff, to apply and teach them some of the things I taught in class, to show them (hopefully) new or different things, so nice. AND, towards the end I even had my own patients which I primarily saw (an AVN patient,
an osteosarcoma patient). These 2 patients in particular touched me because they were so young and so sweet. They were both from Bangladesh, and the boy, Season, was so motivated about his walking, and it was soo nice when we got him up walking. And the girl below was going through radiation treatment and was super sensitive and apprehensive when I first started working with her... had absolutely no active movement and because after her last shoulder surgery she didn't move much, not only was her shoulder joint stiff, but also the soft tissues and skin around it. BUT by the end we were goofing around (as much as we could with the language barrier) and she loosened up. Better yet by the end of my stay she was able to lift up her arm and eat as well as reach behind her head. Ahhh.... sniff sniff. I know it sounds like a little, but those 'little things' mean sooo much to a patient when they can't do it.
So yes, their patients are definitely different than what I would normally see in the US as here even in outpatient ortho we saw neurological cases, cardiopulmonary cases, even pediatrics as young as 6 weeks! etc. So yes, learning experience for me as well!!
(Above: not the 6 week year old!)
I think the biggest observation of the Indian culture is that they are EXTREMELY reserved. In the class setting they would NEVER ask a question nevertheless answer it. Not to say I was a big fan of teachers calling on me, BUT I almost was feeling down that there was absolutely NO interaction during the lectures. Then the director told me, and actually previous volunteers through a Volunteer Trip Report, that that is how the Indian culture it. It is actually seen as rude to answer a question or even speak up because it is almost as if you were putting the teacher on the spot... and of course you actually DON'T want to be seen as a "superior" amongst your friends. Soo... I just tried to make my lab sessions more interactive and also that I can be easily approached. Funny thing was just being there for 3 weeks I went from being called "ma'am" and "madam" to Ellen... it did take at least 2 weeks for both of us to get familiar and comfortable with each other. Ahh... the good 'ol teacher/student relationship.
They were very respectful to me and as with any class, some were very inquisitive and eager to ask questions and others almost avoided me. So again, that dynamic was always interesting. And I have to admit I had my favorites as well that I tended to hang around more.
The thing that was the most interesting is how their system works in the first place. They get referrals for 1-day, 3-days, or say 1 week + (more serious conditions). Also a lot of flexibility with that and it is fairly easily for a therapist to ask for more. Being that they just have 20-40 minutes with a patient (usually 20, supposedly 40 their 1st visit), hence 16-20 patients/day, they often don't fully examine or evaluate, and just jump into these already-written home exercise program hand-outs. Soo... critical thinking not the best. Of course doesn't apply to all. So I tried to be proactive with teaching them even quick functional assessments and... more importantly, thinking "outside the box" (or in this case, outside of the already written hand-outs). I had to be very very polite and cautious with my constructive criticism, i.e. when a staff member asked me why I was concentrating on a hip (with a particular knee patient) than the knee. A big part of me (in my head) was to jump and be like "WHAT?!?!? That is soo basic! You ALWAYS assess the joint proximal and distal to the affected joint!! Helloooo??" (I would never really say that). But I instead I answered politely and non-confrontational.
But anyhoo, below are just a couple of many things I caught them practicing that I taught them, YEA!!!
Closed kinetic chain for rhythmic stabilization.
Well, they know this, but this is Level 1 core exercise of marching with abdominal bracing. This gentleman had low back pain and the scene before this, he was working his upper abs for superficial strengthening (NYET), and I quickly jumped on the scene to address core strengthening.
Gasp, they weren't familiar with the sleeper stretch for posterior capsule shoulder stretching! This is the BEST exercise for that and to increase internal rotation ROM. I also taught it in standing. It was SUPER rewarding to see them actually use techniques I taught! Woo hoo!
As this is a Christian hospital, as far as insurance, I think everyone has to pay a very nominal fee, like 50-100 rupees ($2-3 USD) and as I understand it "we overcharge the rich (those with private insurance) and undercharge the poor." There are also many donations that come to CMC so EVERYONE gets treated. They DO NOT turn away patients, which is nice. And I think extra money from these "rich" patients go to patients that can't afford care. So donations come a long way here, as do patients for that exact same reasoning. CMC is known to provide a full comprehensive exam to get a specific diagnosis. Of course there are always infrastructure issues, but where is it not?
Another impression I got, and this is similar to what I saw in Ghana, was that families are 110% involved in the patient's care. There was ALWAYS at least 1-4 family members with each patient.
So yes, the gym got pretty crowded sometimes! And also we had to explain not just to the patient exercises, but also the family member. It was tiring at times, especially with the language barrier. I think I am now a expert at hand signals and demonstration because I am proud to say that I think most of the patients seemed to understand what I was doing ("seemed" is the key word! I tried to have them repeat what to do to confirm, but who knows!). I also picked up on a few lingo tips that I found helpful... they say "loose" for relax, "level" for straight (like "level your knee), and some other little things.
Also similar to Ghana than my other volunteer experiences was that patients typically seek help when their state is chronic... or very debilitating that they finally seek medical help. So we saw a LOT of arthritis and osteoarthritis patients. Again, because of this I had to revamp a lot of not only lectures but also my clinical help because of the fact that I am used to seeing acute patients, so the examination/evaluations were a bit different, as well as the interventions. As I observed in Ghana, and same as in India, the people can take a lot of pain and suffering.
My last day we had a finale party! It was soo nice! They gave me this Indian outfit that I am wearing as a gift as well as a CMC plate. Then the director gave a nice speech, I gave a little speech, and then we passed out certificates to the staff that had 90% attendance or higher. There were actually a lot of participants!! It was really fun!
Samual, me, and Andrew... SUPER SUPER SUPER nice and helpful to me! They are the main people in charge of the PT department.
Andrew giving a speech about me! Sniff sniff.
Again, besides the outfit I am wearing, they gave me this CMC plate. Very sweet and thoughtful!
Me giving my speech! I thanked them for their time and attention, and highlighted some key points of my lectures I wanted to emphasize.
My audience! The 40+ staff that came to my lectures.
And finally (pics above and below) presented certificates to the individual staff.
Soo.... besides the hospital volunteering, which took about 90% of the time, I did a little sightseeing via autorickshaw of course!
I was invited to their graduation, which was nice,
This is a tradition to have a 95 foot jasmine (similar to a garland in the states) chain for a graduation. It smelled beautiful and both aisles had it (luckily I was sitting next to the aisle and could smell it!). I understand it took 80 people 4 full-days to put it together!
Me with Andrew (on my left), the director, and Samuel (on my right), the manager of the PT department.
They have this funny tradition where after the graduation there is a dinner and the newly graduated students serve the staff. Nice!
Me with Sylvia (on my left) and Winrose (on my right) - my fave PT's!
and also ventured to the pool near campus,
and visited some of the bigger sites in Vellore, the Golden Temple (HUGE temple!) and a Roman Catholic Church.
All right! I've been thinking and was a little anxious about this teaching thing since I left the States for my travels, sooooo it feels nice to be all over. Phew! Next stop, Varkala! It is in Kerala, all the way at the bottom of India (literally, the very very end). I am meeting with some friends I met on the Arctic Circle M/S Expedition Trip I was on, so it will be nice to be with people I know while I am maxin' and relaxin' on the beach for the next 3 weeks! So until then!
