Service Learning With an O&P Study Abroad Program
June 2015 Issue
Sometimes the best lessons in the O&P profession can't be learned in the comfort of your own country. That's what students in the University of Pittsburgh (Pitt), School of Health and Rehabilitation Sciences, Master of Science in Prosthetics and Orthotics (MSPO) program say after treating patients and attending a professional conference in Ecuador. And they say that they hope other O&P students find ways to test their comfort levels by working in cultures that are different from their own.
The new study abroad program at the university came about due to student requests. Students Sara Lustusky and Amanda Gilarski approached Santiago Muñoz, CPO, the Pitt MSPO orthotic coordinator and an orthotic and prosthetic instructor, and co-owner of an O&P practice in Ecuador, with their idea. Lustusky and Gilarski say their instructor loved the idea. Lustusky says that although they didn't know what shape the program would take, they thought that with Muñoz's international connections he would be a good person to approach with the idea. "He was all for it, was really enthusiastic, and immediately he said, 'All right, let's do this.'"
Muñoz says it makes sense for O&P students to learn more about the profession abroad and the patients served. "Right now we are living in a world with the globalization of everything," he says. "Our students in O&P should not only be looking at issues here, but they should be thinking about global issues and conditions as well."
Muñoz immediately began developing a program. Since he was already organizing a Latin American forum for the International Society for Prosthetics and Orthotics (ISPO)-the 6th Uniting Frontiers Forum in October 2014-he decided to arrange the study abroad trip around the forum so the students could talk with practitioners from around the world. He also thought it would be important for the students to put their skills to the test. He contacted his practice in Ecuador and asked people there to be on the lookout for patients who needed help. With the plan in hand, he submitted the proposal to the university.
"The project was approved by the university, and it was considered an official study abroad program," Muñoz says. He and six students planned to go to Ecuador, spend a week treating patients, and attend four days of the conference. As an official study abroad program, the students were individually evaluated on their application of key elements of the MSPO program, which included ethical issues in healthcare, evidence-based practice, clinical pathology, biomechanics, materials, equipment, and fabrication, to earn college credits.
An Unfamiliar Country and Language
For many of the students, a big part of the challenge was simply being surrounded by another culture; even a trip to the grocery store was a culture shock for Gilarski, as it was her first time traveling outside of the United States. Translators were available to help the students bridge the language barrier, and yet it could still be difficult to figure out exactly what their patients were thinking and feeling, the students say.
"We learned how to use our intuition a lot, and you really had to challenge yourself to figure out what was going on," Lustusky says. "We had translators, but diagnostically, you had to use your powers of observation."
While it was a challenge, it was also the point of the trip, says Leah Wolfe, another MSPO student.
"[I] went on the trip because I thought it would be an excellent opportunity to hone my patient skills," she says. "I wanted to learn how to address people from different cultures and help them to the best of my ability."
Another lesson the students took away was the difference in materials used by the O&P professionals in Ecuador. "It costs them too much to import the plastics [we use in the United States], so they have to use different fabrication techniques," Gilarski says.
Muñoz used his contacts to line up patients in Ecuador for the students to assist-patients who were not able to get O&P care otherwise. They helped a marathon runner find a better running solution, they helped cast a patient with a hip disarticulation, and they fitted three patients with cerebral palsy with six orthoses. There were also two other patients, however, who the students say made the biggest impact on them.
The case that was the most emotional for many of the students was an 18-month-old girl with a congenital condition that kept her from developing knees and legs beyond her femurs. Lustusky says that the girl was falling a lot but was unable to receive basic prostheses from the government because her physician decided she wouldn't need assistive devices until she was 15 years old.
"That kind of blew us away, and we didn't really understand the reasoning," Lustusky says. "Basically her parents went online and sought help. They weren't going to take no for an answer."
The students casted the girl for stubbies and fitted her residual limbs with pediatric gel liners. At first, the child screamed because she didn't understand what was going on, says Wolfe. The parents became worried because of her reaction, and Muñoz had to calm them. He reassured them that she was crying because she was confused and had never had this experience before, Wolfe says, not because she was in pain.
In the end, it worked out. The students were all there when the toddler stood on her own for the first time.
"Her mom cried when she saw her stand for the first time; it was a beautiful moment," Lustusky says. By the end of the week, the girl was crying when she wasn't wearing the prostheses, Wolfe says, and was asking for her zapatos, her shoes.
Another case that affected the students was helping to improve the life of a polio survivor. When he arrived, the 56-year-old man was using bilateral forearm crutches to walk. The students observed his knees bending backward, measuring between 40 to 45 degrees.
"He was an active person, but walking for him was exhausting," Lustusky says.
The students say they were challenged by the case. In the United States, polio has been eradicated for so long that patients with those kinds of mobility issues are rare. To help him, the students fabricated bilateral KAFOs and adapted the braces to accommodate for his plantarflexion contractures.
They weren't there for his final fittings but watched by video as he tried on his new braces and walked down a hallway. A later video showed how he had progressed to walking with just the aid of a cane.
"His quality of life has improved significantly," Lustusky says. "It's incredible that something we made was able to do that for this gentleman."
Overall, the students say that working with patients abroad brought home the overall process of what their jobs would be like. For one of the first times, they got to see a patient through the entire process.
"We had a fantastic setting in which we could accomplish a lot in a short amount of time," Lustusky says. "In clinicals, you see snippets of a patient's life. But because we were with the same patients almost every day for a week, we got to see everything from start to finish...."
The hands-on experience was so impactful that Lustusky, with the support of David Ortiz and the rest of the students, submitted the polio patient experience as a case-study abstract that was approved as a poster presentation for the ISPO 2015 World Congress in Lyon, France, later this month.
The ISPO Conference
Helping patients was just part of the program. Muñoz also wanted the students to learn from international O&P professionals. "My intention was to expose them to the challenges of practitioners from other parts of the world," he says. Wolfe says she realizes that even though some things were different, O&P professionals in the United States and Ecuador share many of the same challenges.
"We are all having problems being recognized as medical professionals instead of as durable medical equipment suppliers," she says. "I was able to talk with a lot of different practitioners and hear that they were all pretty much on the same page. I was glad to see that we are all looking to the future of our field and [how to] make it better for our patients. It was an invaluable experience for me."
Gilarski says she saw that even though the healthcare systems of the United States and South America are different, there are still a lot of similarities. "They had a different kind of healthcare system...but just talking to them showed me how passionate they were to get a high standard of care for their patients, which really inspired me."
Lustusky says that talking with the professionals helped her learn about how she wants to approach her career. She sees herself continuing to give aid abroad, but conversing with the professionals helped her realize that this assistance can be provided in an inappropriate manner, no matter how well-intentioned it might be.
"What I learned from the conference was to be aware and conscious of the ethics when you go about helping out cultures you might not understand," Lustusky says. "It's not about going in and making yourself feel good. Because I don't live there, part of my job will be to make sure [that] the society will be able to sustain itself so eventually they won't need outside aid."
A New Way of Thinking
Beyond the learning experience and helping others, the students and their instructor say one of the best things they got from the experience was their problem-solving skills.
Student Briana Suppes says she has already put her new skills to work. At an externship she went to after the program, she chose to use a specific joint on a KAFO in the same way she had seen it used in Ecuador. "They [asked], 'How did you think to make it like that?'" she says. "We learned how to do things that we wouldn't have thought of originally."
She says that she and many of the other students plan to return and hope to see their patients again, especially the toddler. "We have every intention of going back and seeing those patients again and again," she says. "We'll get to see how the little girl grows up through the years."
Experiences like these are the beauty of such programs, Muñoz says. "By studying abroad, it led [the students] to think about other possible treatments and other solutions that they may have never realized otherwise. It will help them grow into well-rounded practitioners."
Maria St. Louis-Sanchez can be reached at .