By Kathy Barnum, MS, OTR, CHT

In June of 2008 I had the unique opportunity of traveling to Managua, Nicaragua as a CHT. Many local therapists have responded to my experience enthusiastically with “I have always wanted to do that!” Well, ditto! Although I have seen volunteer opportunities for OTs, the prospect of working overseas in my chosen specialty area, as a CHT, was thrilling. I learned of Health Volunteers Overseas (HVO) by word-of-mouth at the final local meeting of our Denver Hand Special Interest Group in April, less than eight weeks before the scheduled trip!

Kathy Barnum OTR, CHT teaching Median Nerve Glides to the Physical Therapists at Militar Hospital, in Managua, Nicaragua.

Health Volunteers Overseas is a private, nonprofit organization whose mission is to train local healthcare workers in developing countries. In Nicaragua, the hand therapy program is linked integrally with the hand surgery program, and our mission was to teach splinting and therapy skills, as well as to demonstrate how our two professions -- hand surgeons and hand therapists -- work as a team, providing care to persons with hand injuries. Our June trip was to be the maiden voyage of this combined service in Nicaragua. The hand surgery group was spearheaded by Bill LaSalle, MD from Indiana who was joined on this trip by Jim Strickland, MD. I was going with Kay Ahern PT, CHT. Kay, our fearless leader, had traveled to Nicaragua along with Dr. LaSalle to make the necessary contacts and to lay the groundwork for the program. Barb Koczan PT, CHT from Baltimore, who had previously traveled with Dr. LaSalle on a trip to Honduras, completed our trio of therapists for the one week trip.

Kathy Barnum OTR, CHT demonstrating to Heidi Guitierrez, an OT at Lenin Fonseca Hospital in Managua, Nicaragua a technique for static progressive splinting on a patient with a wrist contracture after a distal radius fracture.

We were to work at two hospitals in Managua. The public hospital, Lenin Fonseca, serves the entire country of Nicaragua, as a training hospital that is a major national trauma center. Hospital Militar serves both private and military personnel. Our primary contacts were physical therapists, with one occupational therapist at Lenin Fonseca Hospital. The HVO philosophy is to try and utilize supplies indigenous to the region to make the clinic as self sufficient as possible. We were able, however, to bring in thermoplastic materials and strapping supplies through donations of our local vendors. We purchased and donated electric fry pans from a local store, although hydrocollators were available in both of the clinics.

The week began with a gathering of therapists, surgeons and orthopedic residents. Surgical candidates were presented to the group for evaluation and, as appropriate, were scheduled for surgery during the week. At this point, as hand therapists, we had some inkling as to the splints that might be needed following the surgeries, and the information that we would need to teach the treating therapists to care for these patients post-operatively. In the clinic, treatment techniques for hand injuries looked familiar with scar massage techniques and joint mobilization techniques, as well as the use of limited modalities. However, the use of custom splinting in any fashion was a new concept to the therapists. Experience with post-operative interventions was also limited, with the norm being to immobilize the patient for 6-8 weeks prior to any therapeutic intervention. Our challenge was to treat the patients post-operatively, provide enough information for the patient to be treated safely and initiate a grid for imparting information on evaluation, assessment and interventions. We were able to treat patients alongside the therapists in the clinic, perform some one-on-one instruction and provide two formal lectures, one at each hospital.

Kathy Barnum OTR, CHT and Barbara Koczan PT, CHT teaching Carpal Tunnel Syndrome evaluation and intervention techniques to the Physical Therapists at Militar Hospital, Managua, Nicaragua.

Language was a huge challenge, as only one member of our group spoke passable Spanish and none of the therapists spoke English. We relied solely on interpreters. The staff, however, was friendly and open to our efforts. There is still a great deal of work to be done. The commitment of the organizers is to build a knowledge-base and develop skills for both surgeons and therapists at these hospitals with visits every four months. This will surely provide positive outcomes for the people being treated now and in the future. I look forward to returning to Nicaragua soon and would encourage anyone who feels that tug to travel, share and teach to explore this HVO opportunity.

Volunteer opportunities are now being accepted for 2010. For further information on HVO, please visit our Web site at www.hvousa.org.