Encountering Rural Hand Therapy Challenges in Mexico
In my Level II rotation and for years afterward, I had the grace of being able to work with therapists in Merida, Mexico in a variety of settings and healthcare models. The systems in Yucatan, Mexico are multilevel and range from shaman and local healers, to Star Medical, which is very similar to the facilities in the US, and everything in between. Culture plays a large part in healthcare beliefs and delivery, and in the state of Yucatan, the population is heavily rural and indigenous (primarily Mayan).
The first trip, we toured the state, spoke with many community and medical professionals and analyzed how communities, beliefs and systems interact. The second trip was three months with part in a hand clinic and part general outpatient. No advanced training was required for the hand therapist, though the OTs I worked with were inventive, client centered, knowledgeable and regularly sought out educational opportunities. Visiting rural cities, rehabilitation was transient, if present at all, and took place in public spaces such as a library or community center. The more rural the clinic, the more likely family and friends were involved in the therapy process. The cultural beliefs combining with therapy provide a very holistic frame for returning to roles and participation.
In the city, hand therapy looks very similar to the clinics I have worked in here, with a variety of conditions from neurological to orthopedic. What really stood out to me was the resourcefulness of the therapists and the people of the community and how daily challenges to participation were solved. I regularly saw items built to complete a therapeutic exercise (for ROM or coordination), mobility (a wheelchair combined with a motorbike), and items for stabilizing while cooking or sewing. It was so amazing to be able to learn from the therapists and community practitioners and be involved in their process, and I look forward to the next adventure.