Thankful for OT

As it is Thanksgiving, I thought I would take this time to reflect on an OT experience that I had earlier this year, that I am endlessly thankful for. Of course, I am thankful for every OT experience I have had, but I thought this one might offer a somewhat unique view of the profession. Thus, I present to you a (rather long) summary of my time in Ecuador this past summer, where I worked with individuals with Hansen's Disease...

(Names of patients have been withheld to uphold HIPAA)

“You are all beautiful flowers. You are a lovely garden.” These are the words of M. Said to us after we took him through his exercise program to help with his lower back pain. The beauty of the moment was somewhat lessened by one of my teammates looking around for the flowers. It took a moment to explain the nature of metaphors and but understanding was eventually attained by all. Nevertheless, these were not the first nor the last poetic words of gratitude that we heard those five days we were at the Damien House. The kindness, love, and thankfulness that we experienced that week were unlike anything I had experienced before. 

The Damien House provides inpatient services to around 20 residents with Hansen’s Disease (leprosy), as well as outpatient services to non-residents with Hansen’s Disease. It is located near downtown Guayaquil, Ecuador. The group from our university consisted of 9 OT students, 9 PT students, and an OT faculty member and a PT faculty member. During our time there, we provided OT and PT services to both the inpatients and the outpatients of Damien House. 

A typical day in the clinic started around 8:30 am. We walked the couple of blocks from our hotel to Damien House. Upon arriving at the Damien House, we were immediately greeted by the gatekeeper, who was usually one of the residents that we had treated, or were going to treat. They unlocked the gate and let us into the courtyard. Every day, without fail, our second greeting came from an elderly man named S. S is also one of the residents at the Damien House and he was there every day to greet us with a hug and a kiss on the cheek, the typical greeting in South American cultures. 

For working in the clinic, our rather large group was divided into teams of four—two OT students and two PT students. This gave us the awesome opportunity to work with the professionals we will most likely be working with when we graduate and plunge into the real world. And of course, we had to have team names, mine being Team Zapatos. Zapatos, the Spanish word for shoe, used by us because our first task as a team was to sort the donated shoes our group had brought for the patients. And, we soon found out that our zapatos work was not over. My team’s job on Monday, the first day of clinic, was solely to distribute shoes to each of the inpatient residents at Damien House. Which proved, in some ways, to be a more difficult job than we had imagined. Some of our patients decided very quickly which shoes they wanted. We had one man, J, who came in requesting a pair of “zapatos amarillos”, or, yellow shoes. As luck would have it, we did have one pair of yellow shoes; some snazzy banana-colored Converse with red laces. J was ecstatic. Others took time to deliberate and try on many different options before finally making a decision. E tried on many pairs of tennis shoes before she decided that she would like sandals instead. After many pairs of sandals, she settled upon a silver pair, which she pronounced “muy sexy”. 

Although it was fun helping find new shoes for everyone on Monday, we were excited to be in the clinic for the next few days, finally putting our school smarts to good use (more or less). Needless to say, there were triumphs and there were letdowns. I wish I could tell you about every single patient that we saw here, but that would take a book. So, I will relate just a few important and meaningful points at this time. 

Overall, many of the patients’ complaints were similar. Hansen’s Disease (HD) is a bacterial disease that affects primarily the skin, nerves, and eyes. So, we dealt with a lot of neuropathic pain and loss of sensation in the clinic. Although many of our assessments and treatment interventions were similar from patient to patient, it never felt repetitive. Because each person we worked with was unique and different. For the most part, the outpatients traveled around 2-3 hours to come to Damien House. That trip usually included both walking and bus rides. They got to the clinic around 8:30, and would wait there until we were able to see them, sometimes not until the afternoon. Thankfully, the Damien House serves lunch to all inpatients and outpatients that are there that day, but that doesn’t detract from the fact that they have to take a day off work and wait for possibly a long time until they can see us. It’s rather intimidating for someone who’s still just a student! But any intimidation is lost once we interact with the patient. Each person we treated was incredibly kind, patient, and grateful for whatever services we could provide. I can make that generalization without any worry of exceptions. 

Often, as an OT, I was teaching the patients energy conservation strategies and ways to relieve pain, and assessing sensation and performance of functional tasks. At one point, I did get the chance to take range of motion measurements for a patient’s fingers. When I learned it in class, I was not a fan, and therefore never thought I would be excited about something like that, but I was ecstatic. It makes such a difference to see the practical application in action! We had also recently learned about using support hose (TED hose) for patients with swelling and pain in their legs. TED hose are notoriously difficult to put on, because they are extremely tight. When I did a week of fieldwork at a skilled nursing facility, I heard at least one patient complain about wearing TED hose at least once a day. I ended up providing two patients at the Damien House with TED hose, teaching them how to put them on and when to wear them. The first man said, “My legs feel so fresh, so much better!” The second woman started crying and explained that she often feels down about herself because she feels like she can’t walk well because of the pain, but she felt so much better with the TED hose. 

My other notable triumph was the successful building of a rolling walker. And by building, I mean taking all the parts out of the box and following the directions to put them together. For someone who has not built many things and avoided building things, it was very exciting. Even more exciting because I put together the walker for an elderly resident of the Damien House, A. He had used a walker in the past, but it broke. Since then, he had been walking with a cane, but had fallen multiple times. A had a lot of anxiety following the falls, and had been using a wheelchair since. We taught him how to use his shiny new red walker, and then took him out for a trial walk around the courtyard. “Ready to sit down?” we asked him after taking a lap. He responded with an enthusiastic “no”, and informed us that he wanted to keep walking. Which ended up lasting for another 20 minutes. It was beautiful.

I would be remiss if I didn’t mention the wonderful leisure opportunities the residents at the Damien House provided us with. On Wednesday, we spent an hour and a half in the afternoon playing Dominoes with R. Every time, R counted up the dominoes that had been played, and the amount of dominoes left, and was able to accurately identify who the winner would be. On Thursday, we played a lively game of “ladder golf” (or “escaladra”, as they call it at the Damien House) with G and M. Escaladra is a huge hit at the Damien House, and we had quite the little crowd cheering us on during the game. 

Throughout the week, I had moments where I realized just how difficult it would be to leave all these wonderful people. This feeling increased as the week wore on, and on Friday, our final day at the clinic, I realized just how fast our time there went by. It had seemed like we had just got there, but in reality that was about 50 pairs of shoes, 100 patients, and 100 SOAP notes ago. We had accomplished so much, but there was still so much to do. There will always be so much to do. The difficulty is choosing what is most important and focusing on that in what little time we are given. Which I just realized is basically a rewording of Gandalf’s famous “all we have to decide is what to do with the time that is given to us”, but that only makes it all the more true.

On Friday, the residents of the Damien House threw us a party to thank us for our work. They showered us with gifts, and each resident had the opportunity to say a few words of gratitude. There were very few dry eyes in the room. It also seemed incongruous, because I think we all felt like we should be the ones thanking them. Our work there seemed small compared to the outpouring of love we received from them. Thankfully, we also got a chance to express our gratitude to the people at the Damien House. It was difficult to put into just a few words everything that they had done for us. One of my classmates said to them, “We came to serve you, but you ended up being the ones to serve us, and change our lives.” I think this expresses some of those feelings very well. It was sad to leave all our new friends, but there was so much love and meaning in the relationships that we had formed, that it felt like we would bringing them all with us. They promised us that they would never forget us, and I can very easily say that I will never forget them.