The streets of Cayo; District of Hospital Sabogal

Todays tasks at work solidified my notion that one really can do more with less (accept the toilet paper and soap of course).  This is particularly true in the field of physical therapy.  While it is nice to have pulleys, gym equipment, therapy balls etc, the reality is that very few people (in the U.S. and Peru) have these supplies in their homes.  What many people do have, however are old bicycle tubes, books and electrical tape.  The physical therapists in Peru do not have a budget and many cannot afford such simple supplies as a belt, Theraband and tape.  So, they get creative.  Bicycle tubes become Theraband, books become weights and electrical tape becomes sports tape.  And it works.  Seems to make perfect sense.  Why not use the same material in the PT clinic that the patient will use at home?!

Each day I tell the therapists I would like to watch them treat patients and if they have questions, they can ask and I will offer suggestions as needed.  It never seems to work out that way.  I arrived this morning and again, hospital staff and therapist's loved ones were lined up for me to treat. A little frustrating since I am eager to see how they treat patients so I can accommodate rather than change their way of treating.  I am still amazed that every treatment booth I pass,  I see 4-5 patients laying on the beds with one of four modalities: e-stim, hot pack, cold pack or ultrasound.  Nobody talks during treatment.  I have yet to see any of the patients doing any sort of exercise.  Most patients in the clinic are 6-12 months post-op and have severe atrophy.  From what the therapists have mentioned most of the patients have pain so the therapists use modalities (for up to 3 months or more!!!).  I explained today that some of their pain might be due to the fact that their muscles have 'been asleep' for so long that there is nothing stabilizing the joint.  By the end of the day I saw one of the therapists give a patient an exercise I taught them and they explained to the patient that their pain could be due to their lack of strength so they were going to start working on strength!!!   It is nice to see the teaching being put to use!

I talked to Maria (my translator) in great depth today about how the hospital is run.  She said the physiatrists are the 'dictators.' The therapists have to do as they say.  I did suggest that it might be helpful to show them some of the treatments sometime to show them that they are effective.  The head physiatrist attended my talk this afternoon and came up to me after to say he really liked what I had to say.  I had Maria fill him in on the Mulligan technique that I taught the PT's the last three days and he asked 'does it work?'  There happened to be a patient in the room so I suggested she show him one of the techniques.  She did very well and the patient made great gains.  She said that was the first time he has ever seen a therapist at work.  I told him a lot of the mobilizations are much more effective with a belt and asked if there was any way of getting a few for the department.  He said he would see what he could do.  I think this inspired the PT's  to bridge the gap in communication with the physiatrists and be proactive about their needs.  They were very shocked that I wasn't afraid to talk to him.   Essalud is a social security hospital.  It provides Peruvians with healthcare services based on regular contributions made through earnings.  Maria said they have many patients that come back many times and the therapists get very frustrated by this.  She said they will also see a lot of chronic pain patients, which she says 'they ache all over even their hair!!!!!!' That was probably the funniest thing I have heard all week.  In 2010 a bill was passed for universal healthcare.  One of the hospitals is in Cayo (which is the same district as the hospital Sabogal.) It is very large and quite crowded.  Although Maria said Essalud is even more crowded and they are trying to find a solution.  Maria and I took a short walk around Cayo after work.  We only had 15 minutes before we had to meet the van but I think that was long enough! The streets of Cayo did not appear to be a great place to roam.  There were many stray dogs in the streets eating trash, all of the houses are barred, including the roofs-they have barbed wire lined broken bottles to keep people away.  I am very fortunate to be staying in Miraflores. Pictured below are two photos taken on the streets of Cayo, and one of the National Hospital (universal healthcare).

Tomorrow will be my last day at Sabogal then I will prepare for my stay at Hospital Alemenara.  This will be much closer which will be helpful.