Update May 15, 2008
By Michael Lear
Now in its fourth year this program continues to take on a life of its own. Our intention was to implement two trainings for therapists at Navajeevana and the surrounding communities, but the massive facilities expansion at Navajeevana and the staff now working six days a week to meet the ever increasing demands made it difficult for us to carry out group instructions and interphase with their clinic operations. Our planned activities had to be postponed until next year.
We have managed to deliver the two Massage tables donated by Oakworks Massage Tables of New Freedom, PA, and we held private training sessions for the therapists who had the time after their work to dedicate to learning more and reviewing techniques already taught.
In particular Samantha Udagama, spent over 14 hrs in private training sessions. As the lead therapist offering Trager based muscle therapy at Navajeevana, he was anxious to stay on top of his skills. The training that he has received in the past enabled him to find work at a local resort during the tourist season and secure a popular place among the European clientele. During one of my visits to Navajeevana, Samantha was treating a former patient of mine, Mr. Premadasa. Mr. Premadasa was smiling and very happy at his new found and sustained comfort.
Last year he was almost 100% debilitated with a pain level of 8 which plague his days even with out working. After treatments, the pain would return within 4 days. During this first visit, I learned that Mr. Premadasa is working hard labor in the fields for up to 7 hours and only experiences discomfort after especially long and challenging days. He remains comfortable for up to 20 days at a time even with this exponential increase in physical labor. Most importantly he is very happy, empowered by his newly regained physical strength and has a bright outlook for his future. (It must be noted here that he was suicidal just two years ago and had self admittedly purchased poison to end his life because of his pain.)
Samantha Treats Premadas 2008
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After Second Treatment 2007
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After 5th Treatment 2007
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Additionally, as a result of his commitments with the Lilana Fund, a Netherlands based NGO that supports Navajeevana, he will be receiving some financial support to travel abroad and receive a formal professional certification in the therapy of his choice. Samantha chose The Trager Approach because of its efficacy with a variety of skeletal muscular conditions and as method of stress management and relaxion training, not to mention its Movement education component.
I spent a few hours with Samantha and wrote a recommendation for him to submit to the Liliana Fund for support and have offered to mentor him through the process.
I also met with Geeth Kumara, a PT student currently studying in Bangalore on behalf of Navajeevana. He expense support previously provided for by CBM has been eliminiated and now he needs to source approximately $2500 for the next three years to make ends meet.
I provided Geeth with two months worth of "pocket money" per the budgeted amount on his contract with CBM//Navajeevana and told him I would seek support on his behalf.
2007 Sri Lanka Physical Therapy Enhancement Training Summary
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Our Real Medicine Team Whole Health Initiative to provide
protocol enhancement trainings to physical therapists in Tangalle,
Sri Lanka and serve out patient clinics was a tremendous success.
The purpose of this initiative was to follow up last year's
program at Navajeevana as part of our commitment of ongoing
training for physical therapists and assistants in cost effective,
progressive treatment protocols such as The Trager® Approach
for chronic and Post Traumatic Stress pain, spasticity, and
neuromuscular disorders. We also provided clinical sessions
for Navajeevana as well as for Real Medicine Foundation's outpatient
clinic at Yayawatta Village. |
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Background:
Navajeevana meaning (new life), now in its twentieth year, is the
only comprehensive private, non-governmental rehabilitation center
in Sri Lanka and funded soley on the donations of others.
It was started to give community based rehabilitation for the poorest
people in this province. It is the only rehabilitation centre which
is providing Physical Therapy, Occupational therapy, Speech &
language therapy, Prosthetics & Orthotics, Wheel chair, Audio
testing, and community based rehabilitation under one roof.
Navajeevana is also conducting a special school for disabled children.
Navajeevana started physical therapy department in early 2000.
The present statistics show approximately 2800 patient visits for
2006. The department major source of funding is from various volunteer
organizations and other NGOs. There is lack of qualified physical
therapists on the island because there are only two year degree programs.
Navajeevana, through support from a german NGO, currently has two
members of its staff training in India who will be returning in 2010.
Until then, in addition to their two physical therapist, they must
rely heavily upon the skill of their physical therapy assistants.
This lack of degreed PT's underscores the importance for PT assistants
to have access to educational programs such as this Team Whole Health
initiative that enhance their skills as a primary care providers without
creating vacancies within the department for long periods of time
or requiring substantial investment. Further, the skills
taught can be easily modified and imparted to lay care givers to empower
them to participate in the healing process. Team Whole Health
Member Michael Lear established his relationship with Navajeevana's
founder, Kumarini Wickramsuriya shortly after the Tsunami and has
since, trained 9 members of staff over the past three years as well
as treated numerous patients in the clinic.
Activity Summary as of May 2007 of
May
Navajeevana Rehabilitation
Center:
In addition to training two new therapists, a PT and an OT, a full
review including more in depth material was provided to four of the
remaining members of their staff that participated last year. Three
have since left. We conducted two weekend long trainings as
well as provided individual reviews. Our case study and other
clinical sessions provided staff members with a variety of highly
effective treatment approaches for conditions such as Ankylosing Spondylitis,
Perio-arthritis and Polio which were not covered in the training sessions.
This year, Mr. Samantha Udagama will serve the ongoing training support
function. While everyone has a solid grasp of the material,
Mr. Udagama exhibited significant understanding of the principles
and he served as my interpreter during most of the clinical and the
case study sessions. I suggested to Navajeevana founder Kumi,
that he be recognized for his participation in all training sessions
and the support he provided to me during my visit. In
addition to Mr. Udagama, physical therapy department head, Mr. A.T.
Arunkumar excelled with the application of this work. Last year
after attending one weekend, Mr. Arun successfully applied the techniques
to a hemipalegic patient suffering from painful muscle spasms that
he was treating while working in the conflict region of Jaffna.
This year, the review of the material further anchored his understanding
of the principles and increased the effectiveness of his work.
For
a more comprehensive review of the Trager® Workshops, please click
here.
For a complete review of Navajeevana
Case Study and Clinical activity please click here.
Real Medicine's Yayawatta Village
Clinic
Through the support of Real Medicine's Sri Lankan Coordinator, Mrs.
Minerva Fernado, I was able to further optimize my time by conducting
over 20 sessions at the Yayawatta village clinic. This clinic
is highly regarded by the surrounding communities and provides most
of the care to this region that otherwise has limited if any convenient
care options. Just one trip on the village trail to or from
the main road will provide testimony to the importance of this Real
Medicine initiative.
On most days I worked in tandom with the visits of Tangalle Hospital's
Dr. Chamal, also of Real Medicine Sri Lanka. Because of
the severity of some of the cases however, I made special arrangements
with Mrs. Fernando to open the clinic at other times to provide care
to those patients requiring more intensive intervention .
While working in the clinic I successfully addressed Parkinson's Disease,
Post Traumatic Stress related pain, Sciatica, Post Laminectomy back
pain, Cerebral Palsy, and pain related to physical trauma. I
also had an opportunity to evaluate and work with Madumekala, who
receives growth hormone therapy for panhypopituitarism through Real
Medicine Foundation's support.
As a result of my involvement at both clinics, I was able to arrange
for Navajeevana to provide Psychological and Physical Therapy services
to Real Medicine's Yayawatta Village Clinic as part of their field
visit activity. Mrs. Minerva Fernando, Real Medicine Coordinator,
Sri Lanka is coordinating this effort with Navajeevana. I've
provided the PT staff at Navajeevana with my clinical notes from the
Real Medicine Yayawatta clinic.
In addition to the training and clinical time, I was able to serve
Real Medicine as a liaison and assist Mrs. Fernando with overseeing
the installation of the water clay sterilizer at Tangalle Hospital,
which was provided for by Direct Relief International at the request
of Martina Fuchs, MD, CEO of Real Medicine. Mrs. Fernando also
arranged for me to visit other RMF initiatives in the village of Dickwella.
We're grateful
to all those who supported this initiative. For a more
detail and a Budget Summary please click \'here\'
Other Activities
In addition to my clinical activities I was able to visit other Real
Medicine initiatives and assess their progress and impact on the surrounding
communities. My heartfelt gratitude goes out to Real Medicine's
Sri Lanka coordinator, Minerva Fernando for her support and dedication
to her community. In addition to visiting pre-schools, I worked
with Minerva to oversee the installation of the sterilizer for the
Tangalle Hospital and the training of the nursing staff responsible
for its operation.
Conclusion
My return trip to Navajeevana provided me with a much greater perspective
of the overall needs of the community in terms of long term, lasting
and effective rehabilitation needs. While there are effective
methods being practiced at Navajeevana, I believe that providing Movement
Education sessions Self Care classes and Relaxation and Awareness
training for the communities being served, could relieve many of the
conditions being addressed and or prevent many from developing to
the degree that need clinical intervention. (As a note,
Dr. Chamal of Tangalle hospital mentioned that 75% of the patients
they see are coming for "pain." While we did not discuss the
origin(s) of the pain, many of the patients are fisherman, subsistance
farmers, and laborers. One may discern from this information
that the pain is related to their activity and muscular in nature.
Utilizing Movement Education table work sessions such as Trager®,
which may be administered without the supervision of a Physical Therapist,
can increase the available treatment options for the community in
terms of lasting pain relief. Whereas many of the PT interventions
observed utilize electro-stimulation or traction to address pain and
require such supervision. Additionally, empowering individuals
through group education of Self Care Movement exercises such as Mentastics®
or Yoga, may have far reaching benefits. Not only will people
learn to relieve their own pain before it becomes problematic, but
community members may begin helping one another by sharing their knowledge
of what has worked for them.
In both cases, movement education models such as Trager®
would leverage therapist time more effectively. Because the
tablework sessions are more a lesson for the nervous system/ an education
process, treatment regimes can be tapered over a relatively short
period of time rather than going on indefinitely, which will free
up existing staff resources to attend to those cases where unique
interventions are indicated. Although more intensive at the
outset this model may provide more efficiency.
The Next Step.
Subsequent trainings have been well received and continue to be requested.
The lack of peer support trained in these techniques underscores the
short term need (1-3yrs) for follow up trainings and reviews to increase
the skill level and. Providing training in group movement education
classes and conducting lay care giver trainings will be a larger component
of these subsequents initiatives.
As we progress with each visit we come closer to our primary goal
to train trainers who can spread this work cost effectively over the
long term.
Please
direct your questions or comments to Michael Lear at michael@bodyworkerswithoutborders.org
or 484.542.0249
To
view Real Medicine Team Whole Health Signed Activity Verification
Documents please click here
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Many in the US are familiar with the effectiveness of therapeutic
bodywork, movement education, acupuncture, yoga and massage in treating
pain, relieving stress and addressing other psychological and physical
trauma. However, these techniques that are so common here, have
not widely reached abroad to countries like Sri Lanka, Pakistan
and Indonesia, recently devastated by natural disasters and in
need of effective affordable health care options.
While most relief organizations recognize the need for immediate
medical care, many have not yet taken advantage of the long term
benefits that cost effective holistic protocols can provide to those
suffering from Post Traumatic Stress, chronic pain and neuromuscular
disorders. Through Team Whole Health, Real Medicine can now provide
both clinical support and instruction in progressive, complementary
holistic healing techniques to physical therapy networks in these
devastated countries.
Unique to these education programs are the benefits that
continue after the trainings. Once taught, therapists can train
others, including lay caregivers, long after the initial costs are
absorbed. Further leveraging the donor contributions and reducing
the cost benefit per patient are the ongoing enhanced treatments
patients receive. Team
Whole Health Programs.PDF
Our pilot initiative to introduce progressive healing therapies
into physical therapy networks in Sri Lanka to aid in the treatment
of Post Traumatic Stress, Chronic Pain and neuromuscular disorders
took place at Navajeevana Rehabilitation Center in Tangalle, in
February and March of 2006. Navajeevana, a community based rehabilitation
center in its 19th year, is the only non-governmental organization
with a comprehensive cross-disability rehabilitation program ranging
from physical and mental rehabilitation to economic and educational
rehabilitation and empowerment. (www.eureka.lk/navajeevana)
In addition to Navajeevana founder Kumarini Wickramsuryia
and her staff, members of the UK based physical therapy group Motivation.org.UK,
who have been assisting with rehabilitation services in Sri Lanka,
were in attendance. (Navajeevana
Project Summary PDF)
Our preliminary goal was to train physical therapists who
do not have access to innovative healing protocols and who are often
inundated by the extensive needs of their poor surrounding communities.
Well received and successfully applied, The Trager® Approach (see below) quickly proved to be an effective adjunct
therapy, enhancing the efficacy of treatment protocols for post
traumatic stress related low back and neck pain from last year’s
tsunami, Cerebral Palsy, Hemipalegia and other injury related issues.
Therapists traveled from as far north as the Tamil Tiger dominated region of Jaffna to attend.
The success of the pilot program has since resulted in requests
for additional trainings as well as the development of a training
program for the blind as part of Navajeevana’s Community Vocational
Training Program. Studies on the efficacy of
Trager® to treat acute psycho-physical trauma associated with mine accidents have also
been considered.
Our preliminary goal for 2007 in Sri Lanka is to commence
in January and provide 3 month-long trainings at Navajeevana Rehabilitation
Center for their therapists, other regional personnel and lay caregivers.
An Introduction of The Trager® Approach for Physical Therapists
This Four-Week Program is designed to impart the fundamental
and most adaptive and effective principles principles of The Trager®
Approach to enhance their mobilization and treatment protocols for
chronic muscle pain, spasms, Post Traumatic Stress related pain,
Cerebral Palsy and other neuromuscular disorders as well as educate
therapists in self-care. The two-day Introductory Workshop satisfies
the Category A Continuing Education Unit requirements for the US
based National Certification Board of Therapeutic Massage and Bodywork.
12-16 CEU’s are awarded by the United
States Trager ® Association to workshop participants.
Note: The program schedule may be modified to integrate
with the existing staff schedules and clinic operations.
The
Trager® Approach
Developed over 70 years ago by Dr. Milton Trager for the treatment of polio
and sciatica, The Trager® Approach remains an innovative
approach to movement education and self care which facilitates lasting
neuromuscular change without setting up burnout or injury for the
therapist. The Trager® Approach utilizes gentle touch
and rhythmic movements to cultivate a state of deep relaxation to
release muscle holding patterns residing in the unconscious mind
that often manifest as functional limitation, or pain. The rhythmic
movements also introduce a new feeling state from which the patient
can recall and experience the associated muscular changes. The effects
of this work are cumulative and, through a series of sessions over
time, can lead to increased self reliance which may reduce the frequency
of visits and free up valuable resources at rehabilitation centers.
* For more information on the complete Trager® Professional Training please visit: http://www.trager-us.org
Program Four-Week Protocol:
Week
1:
Provide technical papers to staff for review of concepts and theory.
Offer Trager® sessions to each staff member for experiential knowledge
of technique
Educate therapists in self care
Hold clinical and peer sessions* for observation and discussion of technique
adaptations
Two day introductory workshop (16 hrs.) on the first weekend
Note: * Permission is
obtained from receiver to allow others to observe.
Week
2
Continue with staff sessions* as their schedules allow
Work 1 day clinic/week, more if requested (Therapists may select and schedule
which of their cases/patients they wish to see addressed with Trager®.)
½ day clinic review session for workshop participants 3-4hrs/week (typically
Friday)
Week
3
Continue with staff sessions* as their schedules allow
Work 1 day clinic/week, more if requested (Therapists may select and schedule
which of their cases/patients they wish to see addressed with Trager®.)
½ day clinic review session for workshop participants 3-4hrs/week (typically
Friday)
Third weekend - two day workshop (16 hrs.) – focus on review of technique, applications
based on clinical needs, and how to teach self care movements
Week
4
Continue with staff sessions* as their schedules allow
Work 1 day clinic/week, more if requested (Therapists may select and schedule
which of their cases/patients they wish to see addressed with Trager®.)
½ day clinic review session for workshop participants 3-4hrs/week (typically
Friday)
Please contact Michael Lear at michael@realmedicinefoundation.org
with any questions. For program cost information/funding requirements
please see cost
summary.
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