�Where to begin?� That was the main question I struggled with, when I first started to volunteer at The Mae Tao Clinic in Mae Sot. There was no such thing as physical therapy, let alone some form of rehabilitation treatment. In fact, no one really seemed to have ever heard of it. I had to make a choice. Leave it the way it is (they already do what lies within their possibilities), or introduce them to a world of endless possibilities.
The first days, I tried to examine and to treat as many patients as I could. There was a lot of work to do, so I said to myself: �You�ve got two hands, use them!�. Eyes got wide open, the medics were obviously curious on what that foreign girl with this hard-to-remember-name and even-more-difficult-professional-description, was doing. It was the father of a boy I was working with, who made me realise that this wasn�t the best way. As I was trying to move the boy�s joints, stretching his muscles and decreasing his spastic contractures, his father looked at me and started to copy my activities. We didn�t speak a word of communal language, and obviously, we didn�t need to. The next day, when I came back, I saw that same father moving and stretching his son again. There was a little girl at the other of the bed. She, at her turn, was copying the way father was working. That was, when I realised what I needed to do: pass on the skills, the knowledge that they need, so that they can do it themselves. That way, they won�t become dependant on that white girl, who has to leave one day eventually.
So here I was, facing a major challenge. Focussing on the long term, instead of instantly treating patients. Passing on knowledge, isn�t that the key to development?
I had to leave all the �luxury� behind and go back to the basics of my work. After all, it wouldn�t make any sense to try and make them work in the way we do in the West. I had to think practically. Where do they really need to expand their knowledge? What sort of skills would they benefit from?
I found out that there is an important gap in between the amputation surgery and the fabrication of the prosthesis. Waiting for the wound to be healed, means: waiting for contractures, atrophia (loss of muscle strength) and loss of physical conditions that the amputee will need once he�ll start to use his prosthesis. It is very likely that the shape of the stump will change once the patient starts walking again, with his artificial leg. That again, will result in fitting problems, possible wounds, pressure sores, or other physical problems due to compensation strategies. We can avoid a lot of troubles by instructing the patient to exercise before the prosthesis is made.
And so, the pieces of the puzzle fell together. I suggested to train a small group of medics and technicians so that they can provide a basic rehabilitation program to the (leg)amputees that are treated in the Mae Tao Clinic. My plan was enthusiastically accepted by both CPI and the clinic, so I parked myself behind the computer for a few long days, again forcing myself to think practically and always keep in mind: �What do they need to know?�. Overloading them would only be discouraging, while understanding what they are supposed to do will make things more easy to remember and stimulate them to actually doing it. So, things must be practical, understandable, but as well �home made�. You will use the things that you made with your own hands better than the things someone else made for you. Because it has a meaning, it makes sense to you and it took an effort to purposely make it.
Based on those aspects, I wrote a 10-weeks training program, that we�ll start tomorrow. Hopefully, in a few months, 6 medics and 2 technicians will be able to instruct the amputees and guide them through the rehabilitation process, with their self-build training schedules, and the amputees well be less likely to have problems with their prostheses. And who knows, if it turns out to be successful, it could be adjusted and used in other CPI-projects as well. But, first things first! Let's start at the beginning.
Lobke Dijkstra, physical therapist and CPI volunteer.
note from James: the video below is archival footage we have from the Mae Sot Clinic, where Lobke is currently working
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