Volume 6, Number 2, 1997

Used crutches, walkers support cross-cultural physical therapy

It isn't difficult to coax Jill Black, Delaware '87, to discuss her relationship with residents of the small town of Ometepec in Central Mexico. In fact, like a proud relative, she brings a photo album of her Latin American patients.

A physical therapist with a passion for cross-culturalism, she has volunteered her skills and time for the last eight years to help the people in this rural, isolated town, which has a hospital, but no rehabilitation programs.

What the community lacked in equipment and facilities, it made up for in the attitude of the people. That atmosphere, discovered on Black's initial visit with her church group, inspired her to create a traveling clinic, finding patients by word of mouth. During her visits, the wife of one of the hospital's doctors houses Black and serves as translator, though Black has been able to pick up some of the local dialect. "I can speak about medical problems and illness," she says, "but ask me about the weather and I'm in trouble."

Black has made the trip to Ometepec 18 times. Sometimes, her patients come back for more treatment and new exercises; occasionally, they bring back their equipment for others to use; often, she never sees them again.

One of her greatest challenges has been in procuring equipment. Luckily, she has lots of people on her side, who rescue discarded crutches and walkers.

"Equipment is something I have made a plea for," says Black. "The donated crutches and walkers may not be up to U.S. standards, but down there, it is better than what they would have, which is nothing."

Sometimes an even greater challenge is dealing with the red tape to get the equipment there. In one instance, Black air-freighted a crate full of equipment only to have it sit in customs in Acapulco. Customs wanted $500. "I refused to pay it," says Black. "It was full of goods donated from here and really wasn't worth a dollar amount." Someone from the church eventually paid the fees, but since then, Black brings supplies with her.

"I've found that I can talk my way through customs a little more readily and explain the cause. We even brought a wheelchair right through with no questions."

Black points in her album to the picture of a man who was brought to her in a wheel barrel. A stroke victim, this man's entire life changed when Black was able to teach him to walk.

"Often, when you stand up a stroke victim, they regain some original tone," Black says. She wrapped his foot with an ace bandage to keep it from dangling and stood him up on crutches.

"You let him get his balance and soon he has a little kick in his hip to jump his leg forward. Basically, he can walk," she says.

Once Black established a rapport with the people in Ometepec, she began bringing some of her students with her. A teaching assistant in UD's physical therapy department for the last six years and a licensed physical therapist, Black has been joined by six students and six physical therapists over the years.

"It's a wonderful experience, especially for the students, because they are put in situations where they don't have all the amenities we have in the U.S. They have to go back to their basic understanding of anatomy, physiology and exercise. They have to be more resourceful. For instance, if they need weights, they might find some rocks and work with those," she says.

Kenneth Seaman, academic co-coordinator at UD's physical therapy clinic who joined Black on one of her trips, stresses how significant Black's visits are. For example, a 9-year-old girl who could not walk had been carried by her friends her entire life. Black gave her a pair of crutches and taught her to use them. She is now self-sufficient.

One of Black's goals is to set up a physical therapy gym right at the hospital. "Even if I go down there periodically for the rest of my life, it will have only so much impact, but training people there will have a lasting value," she says.

In the meantime, she is working to expand her contacts in Latin American countries. She recently visited one of her former students who is doing similar work in Honduras. She spent two weeks in Belize this winter for a UD class, "Cross Cultural Diversity in Nursing." And, she will accompany the organization, "Wheelchairs for the World," to Chile in July.

"My hope is to see just what is there in the way of rehab in these Latino cultures so that we can work on developing a physical therapy curriculum appropriate to the countries," says Black.

Once she completes her doctorate in education, Black says she hopes to teach in Delaware's physical therapy program. "I want to let students know the importance of the cross-cultural side of physical therapy- whether it's going to another country, being more in tune with inner-city needs here or just having someone in your clinic of a different culture.

"We need to learn to develop a greater sensitivity to the specific needs of every patient," she says.

-Donna Speers