Encountering Disability Services with Limited Resources in Guatemala
In 2015 and 2016, I participated in medical mission trips to Guatemala. The organization I went with was through my employer, ATI Physical Therapy. They had a philanthropic international program that brought teams of therapists to Guatemala to work with Hearts in Motion, or the Quiqe Ceron Foundation. During my visits, I worked with both partner organizations.
Although the Guatemala constitution states that healthcare is a universal human right, the healthcare system has difficulty making this a reality. The current healthcare is divided into three segments: public, private nonprofit and private for-profit sectors. During the Guatemalan civil war years, non-governmental organizations (NGOs) started programs to help with healthcare needs. The Minister of Health (MOH) often works directly with NGOs in rural areas. This does not mean access is easy or guaranteed and the indigenous population in rural Guatemala lack reliable access to healthcare. Indigenous Mayans have their own ethnomedical practices, which may create additional barriers to receiving comprehensive care.
The NGOs we partnered with in Guatemala set up daily clinics in different locations and advertised that therapists would be available to provide free therapy visits. During these clinics, patients were triaged using interpreters and then had a therapy visit for approximately 30 minutes. The therapist provided a basic initial evaluation, HEP and potential risks and benefits of the HEP. Each clinic day lasted eight to nine hours and our teams of six to eight therapists saw approximately 15 people each day. As a hand therapist, I provided evaluations for any upper extremity condition and orthosis fabrication where indicated.
Common injuries from birth defects, machine work, farming, auto accidents, gang violence and sports or from health concerns related to dietary changes among the indigenous Mayan such as diabetic neuropathy, CVAs and heart attacks create much need for rehabilitation services. Unfortunately, without a clear route to receive such service, many people suffer unnecessarily. I found it striking that people suffered so much pain and dysfunction due to lack of information. Many were told to keep their limb immobilized, but not told when to resume movement. Without that last bit of information, people were afraid to move and became unnecessarily stiff. Or, families caring for elder loved one’s post-hospitalization had no instruction on making accommodations for toileting or bathing putting them at risk for falls or further injury. When an injured person needs surgery, it is often incumbent upon them to purchase surgical items upfront, such as fracture fixation devices. The financial burden of these purchases may impact a family for years and the outcome for a heroic and expensive surgery may be worse than a limb amputation and I could never tell if patients knew this before investing in the surgery.
There are trained physical, occupational and speech therapists in Guatemala, but there are too few to meet the needs of the population. In cases where we provided care at a facility that already had therapists, I offered hand therapy-specific training to those therapists. The most difficult part of the training for me was trying to use our limited time most effectively. I wanted to respect their base knowledge and still provide something useful and culturally relevant without making assumptions that could be offensive. While both my trips were personally educational and satisfying for me, I often wonder if the best use of resources is sending therapists abroad, or providing low-cost education to in-country therapists.