Managua, Nicaragua is potentially a beautiful city.
There are rich resources in this hot, moist climate that are visible everywhere: a city by a huge lake rimmed by volcanic hills that produce rich coffee beans, lush tropical fruit and beautiful birds in the forests.
Managua was totally destroyed by the earthquake of 1976; nothing remains of the beautiful Spanish architecture built by the conquistadors.
30 years later, the city is being rebuilt.
Some improvement projects are funded in connection with the World Bank.
This organization is maintaining sanitation standards and the plan if any is haphazard.
High rise office buildings neighbor barrios of one room living spaces; one light bulb and the proverbial TV connected to the outside street lamp.
I can envision the children playing in front yards of powdery dust; chickens and skinny dogs sniffing something to fill their bellies.
There are no elders visible; so many thousands of lives were lost in 1976.
The statistic from the Canadian embassy is that 50 percent of the entire population of Nicaragua is under 15 years old!
The expected life span is too short; children get diseases from the airborne dust and the adults work with their hands for a living.
Machete injuries are rampant as well as overuse syndromes from office and "sweat shop" labors.
They need hand therapy badly.
In the U.S., of 1970 physicians did not trust that therapists would not destroy their delicate surgical work; physical therapists likened to drill sergeants.
Surgeons smirked at the joke about the best therapist being a double amputee.
But there were some who did not joke; surgeons named Beasley, Hunter, Madden and Boswick, some who actually believed that an intelligent therapist properly trained could be an ally, an asset and a colleague.
With their support came the dawn of hand therapy and a new era for hand care. Nicaragua is at the pre-1970 stage of development.
The physicians rarely interact with therapists directly, if anything it is via a physiatrist.
This interaction commonly occurs only after surgical repairs are solidly cemented together along with everything else.
As the effects of immobilization can be worse than the trauma itself, Nicaraguan therapists fight a loosing battle.
Given the hierarchy, there is not much they can do but follow the dictated prescription.
For the population of Nicaragua who must accept these less than optimal results, it is a sad state of affairs and a waste of physician effort and of therapist potential.
Universidad Nacional Autonoma de Nicaragua (UNAN) is a university in the capitol city of Managua independent of political affiliation.
It is small and under-funded but on it's way into the 21st century.
Through Health Volunteers Overseas they have asked volunteers to assist in teaching their therapy program to bring them up to date.
I applaud their insight and solution to the lack of qualified teachers in the country.
They have now had three years of teaching teams and I am told the program has advanced the PT program immensely.
Sadly I heard of no OT's in Nicaragua and no OT programs.
There is a void in holistic patient care that needs to be filled.
And so after my 33 years as a hand therapist I decided to move on to another venue to exercise my CHT skills.
I spent this last fall preparing a curriculum and lectures for a program introducing the human body's response to insult and trauma and how each tissue repairs or regenerates itself.
After that introduction, we focused on patient programs.
My thinking was that if they could gain this foundation they could one day interact knowledgeably with the physicians and gain some level of respect.
It was an ambitious idea.
This February I traveled to UNAN with a pediatric therapist named Amy Swenson, DPT; she was my assistant teacher and good companion.
We brought suitcases filled with my lecture handouts (translated into Spanish by Amy), models and illustrations (no PowerPoint or slide shows available here).
The program director met us at the airport in the university pick-up truck and delivered us to university housing for the evening.
This plain cement blockhouse with security guard had a window air conditioner, TV room, kitchen area, 4 bedrooms, two of which were occupied by unknown adult males and one tiny bathroom.
Our room had two single beds, too many ants on the floor, no lock on the door and no running water.
The next morning we checked into a lovely Spanish style hotel.
It was not their fault - the water had been rerouted two weeks previously to complete a building project nearby.
Actually I was thankful to have the excuse to not to do my own cooking!
Back to the teaching, students were from all parts of the country and will one day represent an emerging middle class.
They remained alert and wonderfully attentive throughout the week.
Half the class of 20 was UNAN faculty who asked probing questions revealing their desire to upgrade their understanding.
Thank goodness my brain kicked in and the Spanish went well enough; I give them credit for hanging in there with me as I struggled to communicate effectively.
It was presumptuous of me to think that they could utilize my information in their current situation.
They cannot do early wound care, early splinting and early mobilization of any kind as the doctors will not release the patients.
The very concept of splinting is out of their realm.
I had to delete much of my tendon lecture material as it was not applicable.
I planted seeds for change, I hope.
The undergraduate students listened intently and realized that there exists elsewhere a team collaboration that yields a better patient result.
The professors will teach with a bit more knowledge now although both faculty and students of UNAN expressed their frustration at the status quo in the medical hierarchy.
Things will change; one benefit of TV and the Internet is the glaring awareness of their differences between societies.
Education gives them a path toward change.
I had a fabulous experience.
The days of teaching were long and hot but I enjoyed the challenge and the process immensely.
I hope to return in 2008 to continue to plant my "seeds of change" with better understanding of the hurdles the therapists of Nicaragua face, what they lack in education and what the population needs.
I now appreciate how far therapists of the US have come in the last 35 years and how pleased I am to have been a part of that change.
Biography
Karen H. Prendergast Lauckhardt MA, PT, CHT
Following an undergrad education in Physical Therapy, Ithaca College I gained an M.A. Ergonomics and Occupational Biomechanics, New York University.
Perhaps the highlight of my career were the years devoted to developing the American Society of Hand Therapists.
As a Founder of ASHT I began as Secretary and in 1979, President of ASHT.
My 33-year career in hands began with my work with Robert Beasley at the Hand Rehab Center, New York.
In 1981 I moved to Richmond, Va. to become program director of the new MCV-VCU Masters of Science with Specialty in Hand Management Program–and director of the Hand Management Center.
After my time in Virginia I worked at Lenox Hill Hospital, New York, N.Y.
Greenwich Hand Therapy Center Inc was my first time as private practice owner - a very fulfilling experience with several of my Hand Therapist colleagues.
We closed-up shop in 1997 and then I worked part-time locally in New Canaan, CT.
During my career I have had the privilege to do a lot of speaking about my area of expertise.
I thoroughly enjoyed my speaking engagements in Latin American.
Most memorable of which were:
1976, "Rehabilitation of the Hand," seminar presented in conjunction with Pegge Carter Wilson, OTR, CHT in both Mexico City and Guatemala City.
This was the same earthquake that flattened Managua, Nicaragua.
1986, "Rehabilitation of the Hand," five-day seminar and workshop presented in Mexico City in cooperation with the "Social Security."
Out of this effort came a paperback manual from the writings of Pegge and myself: "Rehabilitaccion de la Mano."
Cirugia de la Mano.
Correa L. Gomez & Guerra, R. Cuinea Salvat Mexicana de Ediciones, S.A. de CV. Mexico 1986.
So now as I move into the next phase of my life, my passion for hands remains but it is shared with a passion for family, pets and ballroom dance.
