Getting There

Following the glow of passing my exam, I felt a bit paralyzed with uncertainty about how to get where I wanted to go in Haiti.  There are many, many non-governmental relief organizations (NGO’s) in action there, and these organizations also work in locations around the world.  Naturally, I want to go with a well-recognized group for my own safety and security as well as for their resources to provide good care.  I worried that in applying to a big NGO it might be difficult to get placed in my desired location.

I decided to start with my target and work backwards to the appropriate NGO.  I was fairly certain that I wanted to go to Hôpital Albert Schweitzer (HAS) (http://hashaiti.org/) in Deschapelles, which is 60 miles from Port-au-Prince and away from the majority of the devastation.   This facility appeals to me for three reasons.  The first is that I feel a need to be somewhat shielded from the most dire situations in Port-au-Prince.  Another is that there is a rehabilitation facility there (http://friendsofhasprojects.blogspot.com/2009_10_01_archive.html) with a clinic established after the earthquake by the Hanger Foundation, which is a part of Hanger Prosthetics and Orthotics in the U.S. (http://www.hanger.com/Pages/HaitiRelief.aspx).   This seems like a good place to work with amputees in the long-term phase of their rehabilitation.  The third appealing factor is that for the past two years, there has been a Rehabilitation Technician Training Program (RTTP) there, in which 6 students follow a 9-month course (http://friendsofhas.org/projects/rttp.php3).  I would like to play a role in helping Haitians train for employment, and to help them learn to help others in the process would be even better.

I started my inquiries with people who were involved with HAS.  I had read about a therapist from NYC, Claude Hillel, who was featured in some articles I found online about HAS (http://projecthopeinthefield.blogspot.com/2010/02/personal-loss-drives-hope-volunteer.html).  He had managed to pull together supplies and get himself to Haiti soon after the earthquake.  He was placed on the hospital ship USNS Comfort, and later helped establish the post-earthquake amputee clinic at HAS.  I found his contact info and sent him an email, and before long he called me.

He was patient and encouraging about my quest, and had a lot of good information.  At the time that we spoke, he was about to head back to Haiti to celebrate one of his patients, a young mother and bilateral above-knee amputee featured in this video http://www.youtube.com/watch?v=PgNB4DYDF-Q, who was about to open a little business selling oil and rice.  This highlighted for me the connections made with these resilient and appreciative people and those who come to feel honored to help them.

I expressed concern about my amputee training, and Claude replied that, because the prosthetists are good at training the therapists at the facility, the more difficult adjustment has to do with the culture and the climate.  I found this comforting in terms of my clinical position, but humbling in terms of the physical and emotional adjustments that I will have to make.

Through a contact that Claude gave me, I contacted the coordinator of the PT program at HAS, Shaun Cleaver.  He was happy to hear from me, noted that they were covered for PT’s through 2010 and hadn’t yet started planning for 2011, and suggested that I contact the director of the Rehabilitation Technician Training Program, Denise English.  This was exciting for me, because the RTTP is where I would love to end up!

So, after strings of emails through chains of different people, I am scheduled to be at HAS through Physicians for Peace from February 3-19 as a physical therapist in the amputee clinic.  Next, I am tentatively scheduled for March 25 to April 12 as an instructor in the RTTP through Health Volunteers Overseas, and then September 3-25 as a clinical instructor during the last phase of the program.

If I get to do all of this, it would bring me full circle in my quest to help in Haiti, beginning with direct patient care, continuing with classroom instruction (in French!) and culminating in clinical instruction and the class’s graduation.  It’s both frightening and exciting!

Résumé of a Full Time Mother

I passed my test!  Halleluiah!  Now, in order to apply to an aid program, I have to develop my résumé.  How do you write a resume when you haven’t had paying work in over 2 decades?  What have I done that would demonstrate my fitness for a position?  I’m raising three wonderful sons; does that count?  How do you quantify that? 

It would be nice if anyone reading a résumé would know how much of the experience of parenting can be translated to success in the working world.  My mother-in-law, a champion of full-time mothers, is fond of listing all the job titles of motherhood:  director of consumer affairs, secretary of education, chief of health care, financial affairs minister, judge, mediator, and advocate, and, I would add, kisser of booboos, instiller of values and keeper of the peace.  Yes, all of those come into play as mothers juggle the endless needs of their children with everything else that goes into creating a loving and functional home.

But just in case, I guess I’ll have to throw in some of those extra things that show my leadership or managerial skills, like sitting on boards and heading up fundraising efforts that raised about $100,000 (twice) for my kids’ school, or coaching recreational soccer.  Or I could list things like the fact that I'm good at communication, can speak French, and can operate a computer.

Toby offered to be listed as a reference:  “Yes, she raised us very well,” he’d attest.  He recently reminded me that I somehow managed to let them get away with two desserts when they were little, calling the milkshake right after dinner “dessert” and the one right before bed “bedtime snack,” for which I seem to have become a sort of folk hero mom to them.

I introduced them to Bob Dylan and Dire Straits.  I let them choose the music while riding in the car and even came to enjoy most of it, even if I did often hit the dial to change from Live 105 to acoustic 92 as soon as they got out at school.  I probably let them watch too much TV, but always insisted on appropriate content.  We held back on movie ratings, often not letting them see certain movies even if they had attained the designated age, while many of their friends were allowed to watch movies rated well beyond their ages.  The years as the boys grew from PG to PG-13 to R were a constant refrain of “But Mom, all the other kids’ parents let them watch those movies!”  We were pretty lame for that, but we held firm, much to their disgruntlement.

When video and computer games started becoming popular, we let them have them only at Bill’s office, so that we wouldn’t have to police their use of them at home, and to give them something exclusive to do when they hung out with Dad while he was working.  A decade later, with electronics so thoroughly permeating their lives, we still try to limit content and time.  But recently Toby and Reed have taken off with Starcraft, playing until the wee hours of the morning. I see this as a good thing, though, a fun means of brotherly bonding, bridging the 6 years between the eldest and youngest before Toby heads back to college:  Toby and Reed against the world.

My sons have spent a fair amount of time in the kitchen. I taught them to bake cookies and exposed them to the delicious pleasure of tasting the dough.  I ensured that they committed to memory the recipe for real rice krispy treats, the original Chocolate Scotcheroos from the Rice Krispy box made with peanut butter and corn syrup, not marshmallow cream, and the exquisite topping of chocolate and butterscotch chips melted together.

Sean and his high school friends, instead of going out and getting in trouble, have bake-offs, vying for the honor of the most delectable apple pie, or the best use of fresh blackberries from the back yard.

I have produced a trio of creative and enthusiastic chefs, capable turning out delicious entrées, barbeque, and baked goods. However, this is the result not of tireless instruction in the kitchen, but rather my frequent failure to get dinner on the table at all, causing them to fend for themselves.  If only I had known what a favor I was doing all those years, what a clever strategy I was putting into play, I wouldn’t have felt so guilty.  These days, however, I can revel in the sweetest phrase to come from a child’s lips:  “Mom, dinner’s ready!”

The Board Exam Looms

I take the NPTE in a couple of days, and I am not as confident as I would like to be.  I’ve learned a lot and taken four practice exams, but each exam throws out things I haven’t studied.  I guess they can’t cover every scenario in the big review book.  I just hope these practice exams have exposed me to enough to pass the real thing.

I’ve been a little surprised at myself all along for “going public” with my dream from the beginning.  Usually, if I have a goal and I don’t know if I can accomplish it, I keep it quiet as I work toward it, so that I won’t be embarrassed if I don’t succeed, or change my mind and decide not to go for it.  This time, though, as soon as I was seized by the notion of reviving my license and going to Haiti, I put it out there.  I’m not sure why, but I think it is because the idea seemed so fitting that I saw it as a foregone conclusion.  I also wanted to pressure myself to keep at it, in case my resolve wavered.  Plus, I am getting lots of support from all of you!

So, here I am at the brink of the Big Test.  Will I pass?  I think I will, but I might not.  I have no buffer zone, as my results so far are just passing.  And if I don’t pass?  I will be seriously bummed.  But I will carry on, because Haiti needs me anyway.  And I can try again.

My Heroes

This patient population is a dream clientele.  They are pre-selected, by temperament, choice, and training, to be hardworking, compliant, and respectful.  They don’t complain.  They are determined to get on with their lives, whether that means returning to their posts or moving on.  These qualities, along with the fact that they were willing to sacrifice for our freedom, makes it an honor to work with them.

The sailor who was injured on his Harley was telling a comrade that the main problem he’d have getting back on his ship is pain management, because no one can be on narcotic pain meds while serving.  But he said that, from his commander to his therapist, everyone was willing to facilitate his return to duty, and that seems to be his goal.

A soldier, who lost his right leg below the knee and had severe fractures with external fixation on the left leg, had been an Army corpsman, or medic.  As for returning to duty, he told me he was “closing that chapter.”  He just signed up for classes through the GI Bill to start working towards a psychology degree, because he likes to talk and listen to people and wants to “help people who have been through what I’ve been through.”

Another young man, “Benton,” is from Belize but was injured serving in the American military.  He has an above knee amputation on the left and a large area of skin grafting on his right foot.  For him, as for many with IED injuries, the rehab for the salvaged leg will be more complex and long-term than the adjustment to the prosthesis.  Still, it is usually more functional and less energy-consuming to walk with a rehabilitated, intact limb than with a prosthesis, so that's why they work so hard to save them.

Benton charmed with his quiet manner, wide smile, and mischevious humor.  He had been a teacher, working with children from first to eighth grades, before joining the service.  He is also very determined.  When he had only done a couple of days of walking in the parallel bars with his new leg, he really, really wanted to take it with him overnight (most of the clients live in rooms in another building on the base during their rehab).  He managed to cajole his therapist to allow this, insisting that he wouldn’t wear it for too long and would be careful to note any pressure areas on his skin.  He left the PT department that day with his prosthetic limb tucked beside him in his wheelchair, the above-knee socket draped over his shoulder and a big smile on his face.

At one point when I told Benton what I was hoping to do in Haiti, he responded in his quiet Caribbean lilt, “You’ll do it.  I can see it in your face.”  Imagine, this young man encouraging me!  Benton, you’ll do it too, whatever it is.  I can see it in your heart.

The Admiral Visits

On July 1, the 5C PT department received a visit from a VIP, an admiral with an entourage that included his wife and half a dozen uniformed personnel.  The admiral was there to show his concern for injured military members, whether or not their injuries were sustained in battle.  His demeanor was equally sincere with the sailor who suffered an incomplete spinal cord injury from a rocket propelled grenade as with the one who got his foot mangled when, as he explained to the admiral, “I was T-boned on my Harley, sir.”  And if the admiral noticed this sailor’s t-shirt touting the Chicken Ranch brothel in Las Vegas, he didn’t show it, pressing a medallion in the man’s palm as he shook his hand.

Afterwards, I Googled Admiral Robert Willard, and learned from Wikipedia that he is Commander of the US Pacific Command. “He is responsible for the world’s largest fleet command, encompassing 100 million square miles and more than 170 ships and submarines, 1,300 aircraft, and 122,000 Sailors, Reservists and civilians…he is the supreme military authority for the various branches of the Armed Forces of the United States serving within its area of responsibility… only the President of the United States, who is Commander-in-Chief of the Armed Forces, and the Secretary of Defense advised by the Joint Chiefs of Staff (JCS) have greater authority.”  Well, OK, then! 

First Day at NMCSD

My first day went fine - I jumped through all the hoops to get on base, cleared through security, briefed on regulations, and photo-badged, all on time.

In Casualty Care PT, I saw several young men with unilateral and bilateral amputations.  In most cases, there is major involvement of both limbs due to the mechanism of injury.  The first person I saw was injured at the end of April in Afghanistan by an IED, resulting in bilateral trans-tibial amputations - unfortunately, a seemingly classic scenario.  He was a very nice guy.  I started by asking him about his workout (he was doing mat exercises on his own) and he just started talking - he has 3 sons, he can't wait to see them, as he hasn't since he deployed in February, and the military is working on getting his family transferred out here.  He was at Walter Reed earlier and was treated like royalty - lots of celebrity visits (military bigwigs, including General McChrystal, visited him).  His wife is with him, and he's pretty independent with a wheelchair, but is just getting started with his prostheses.  I hope to see him each day.

There's lots of new, computerized equipment that I've never seen before, and I got to observe a gait evaluation in the Gait Lab.  There are 12 cameras mounted around the ceiling perimeter of a large room, in which the volume has been calibrated.  Small reflective balls are placed over all the significant joints of the person, just like the motion capture technique you've probably seen on TV.  There are force plates in the floor that capture step forces.  The images are converted to a complex stick figure and graphs to analyze different motions.  Very cool.  Plus, this particular individual, a young woman who is a dependent of a military member (hence able to be seen at this facility) with a congenital deformity and a new prosthesis, had her 8-month-old baby girl with her who needed feeding, and guess who had open arms?  Yay, baby fix!

I'm pretty independent - there is no hand-holding or leading me around, but they welcome me to observe and ask questions.  It will be up to me to seek out opportunities, so I have to be bold and speak up!

Because I Asked

Book-learning and practice tests are one thing; actually knowing what to do in a PT setting is another.  I needed a way to get some hands-on review and training, but I couldn’t find courses by searching online that might serve my needs.

When I took the review course last February for the PT board exam, the instructor, Ed Kane, saw that I had graduated from the same program from which he had, at Duke, and we had a nice chat about people we both knew.  He had just seen my favorite professor and mentor from Duke, Pam Duncan, the previous weekend at a conference in San Diego.  That was a fun connection.

After the course concluded, I thought I’d ask him if he knew of any programs or courses that would help me get some amputee training.  I approached him and thanked him for the excellent course, and he acknowledged me, then moved on to the next person.  Darn.  Opportunity lost.  Or not… as I collected my things, I resolved to make myself approach him again with my question.  I knew I had to put myself out there to get to Haiti, and as a shy person, that isn’t that easy for me to do.  But I did go back and ask him.

He answered that he didn’t know of any courses, but “what you really need is a clinical experience.”  As a retired Navy captain, he mentioned that he knew “everyone” at the PT department at the Naval Medical Center in San Diego.  He told me to send him an email and he would get me hooked up.

Wow!  That would be awesome!  He had told the class that, because of advances in field trauma care, Combat Support Hospitals, and evacuation to the US Army and DOD-run Landsduhl Regional Medical Center in Germany, soldiers survive injuries today that would have killed them in earlier wars.  Consequently, the military hospitals have the most advanced amputee centers in the U.S., and one of the major such hospitals is the Naval Medical Center in San Diego.

If I could do some hands-on work in a setting like that, it would be a great learning experience.  Plus, I would have a chance to work with our injured soldiers, something that would be certain to be profound.

I did send Dr. Kane a message, and he did forward it to the then-chair of the PT department at NMCSD.  About 10 days later I heard from her that she had forwarded my note to the new director, with an optimistic mention that she thought we could work out some hours for me.  I didn’t hear any more for about a month and was about to write back when I heard from the director, asking me if I was “still interested” in an amputee clinical experience.  I assured him that I was!

His message included a string of emails to various other people to see if they could accommodate me.  It was humbling to see the communication that took place:  questions about how to handle my unique non-student status, about medico-legal concerns, about what needs to happen from a volunteer standpoint in order for me to be there.  They mentioned ideas about what experiences they could offer, such as prosthetics, gait lab, and even pediatrics.

Even the Director of Volunteer Services made special arrangements for me, guiding me to complete the volunteer requirements from afar and seeing me on my own for the orientation.  The process for becoming a volunteer at a military facility was almost as complex as my application for PT licensure.  I had to apply to the Armed Services YMCA, provide proof of a negative TB test, fill out a lengthy background check document, get fingerprinted, and finally get a photo ID badge from the office of the Military Police.

And now, here I am, in the midst of a cutting edge rehab department called Comprehensive Combat and Complex Casualty Care, or 5C PT for short, observing and helping hardworking soldiers overcome devastating injuries, a process that they are enduring for their country, for us, for me.

I am here because of the generosity of many people willing to help me get ready to help people in Haiti, but ultimately I am here for one remarkably simple reason:  because I asked.