My name is Becca Halperin, and I recently returned from a trip to Nicaragua where I worked as a physical therapist in a small town called San Ramon in a community of the same name. I spent 2 days a week treating children in a pediatric “clinic” where children came to receive therapy in the Los Pipitos center for children with disabilities. The rest of my time was spent going house to house treating adult and pediatric patients who were unable to come to Los Pipitos for therapy. Los Pipitos is a national organization that works to change the country’s perception of children with disabilities and provide children with a range of services from therapy to integration into the school system.
Health conditions in San Ramon and in Nicaragua are far from satisfactory. San Ramon is one of the poorest municipalities in Nicaragua according to the Nicaraguan government. Many children and adults whom I met at Los Pipitos received no follow up care post-surgery. In the majority of cases physical therapy was not recommended or offered. In those cases where therapy was offered, the first appointment was scheduled for up to 6 months from the date of surgery and many patients were unable to afford the transportation costs to and from Matagalpa for physical therapy treatments. It was truly an eye opening experience to travel from home to home evaluating and treating patients with a variety of diagnoses, ranging from fractures to neurological disorders and congenital malformations.
One severe case involved a child with achondroplasia, a form of dwarfism, who had been through 3 surgeries by the age of 9. This patient received no therapy and taught herself to walk again after surgery using a small tricycle. I will always remember sitting on the dirt floor of their hut attempting to read x-rays by sunlight so that I could gain a better understanding of her medical history, as the family had been given little explanation regarding her diagnosis and they did not understand why their daughter’s legs were once again severely deformed despite surgery.
The supplies we collected from MedShare included gauze, and wound care supplies, sterile gloves, masks, casting material, therabands, splints, orthotics, and tape. We also brought material to fabricate feeding chairs, adjust splints, and create shoe inserts. The staff at Los Pipitos was ecstatic to receive the supplies we provided as medical supplies are very expensive and difficult to find in San Ramon. Many supplies cannot be bought in San Ramon and one must travel 20 minutes by car or 45 min by bus to Matagalpa to purchase items. The wound care supplies were especially useful during our time in San Ramon.
One particular patient was an adorable, 11 year old boy with a diagnosis of Osteomyelitis. The surgeons in Managua, the capitol of Nicaragua, had operated on him 8 times. They had resected the majority of his tibia and part of his fibula, the two bones in his lower leg. He was put in an external fixator which acts as an external stabilizer for bones while they are healing and growing. The fixator has many nails that pass through the skin to the bone creating wounds that remain open for the duration of the time the patient wears the fixator.
The patient’s family had not received any education on proper care and cleaning of the fixator almost 6 months after his surgery. A large part of physical therapy is education and so the first session was spent cleaning out the entrance points to his fixator, and educating his parents. The wound care supplies I brought from Medshare were essential. Without the supplies from MedShare, I would have had to travel miles to purchase even the basic materials such as hydrogen peroxide. We used gauze and a solution of hydrogen peroxide and water, and his parents became experts in cleaning and dressing his wounds. By the time I left San Ramon I felt confident that his parents and the therapist would be able to care for his wounds and have enough supplies to get them through to their next doctor’s appointment.
I hope to return to San Ramon soon to continue my work as a physical therapist with Los Pipitos. Since I left, they have added a hand washing station and a toilet to the facility. I hope to create a sustainable program where PT’s are able to travel to San Ramon at regular intervals and provide new ideas and techniques to the resident physical therapist and child psychologist, as well as, the rest of the staff. It is my belief that training and empowering the Nicaraguan medical practitioners and the patients themselves is a more powerful and lasting gift to the children of San Ramon than any treatment I could provide as a volunteer.
