International Service Manual for Students:

A guide for students considering international service trips

Updated October 2016

Authors: Ashley Alagna, SPT Carroll University

Rachel Buckner, PT, DPT University of Southern California Tessa Comstock, SPT The College of St. Scholastica April Fajardo, PT, DPT Southwest Baptist University

Randy Kaw, SPTA Oakton Community College Christina Machaby Lee, SPT Boston University

Monica Lee, SPT Maryville University of St. Louis Kelsie Miller, SPT Mayo School of Health Sciences

Brittney Townsend, SPT Southwest Baptist University Michael Weinand, SPT Northern Arizona University

Samantha Weng, SPT California State University Long Beach

Editors: Jillian Carney, PTA, BA St. Catherine University

April Fajardo, PT, DPT Southwest Baptist University Josh Greensweig, SPT University of Minnesota Christina Machaby Lee, SPT Boston University

Ryan Maddrey, SPT Medical University of South Carolina Kelsie Miller, SPT Mayo School of Health Sciences

1

Table of Contents Introduction Letter…………………………………………………………………………………..2

I. Vision and Mission Statement…………………………………………………...……….3 II. Operational Definitions…………………………………………………………………….3 III. Potential Impacts of International Service Trips……………………………………....5

A. Impacts on Students………………………………………………………………....5 B. Impacts on Host Communities………………………………………………...…....8

IV. Ethical Considerations of International Service……………………………………...11 V. Choosing the Right Program…………………………………………………….……....15

A. Sustainability……………………………………………………………...………....15 B. Community Needs Assessments and Community Engagement...………...…..19 C. Other Considerations……………………………………………………………….22

VI. Financing your Trip...………………………………………………………………………24 VII. Preparing for your Trip..…………………………………………………………………..26

A. Passport/Visa………………………………………………………………………..26 B. Health, Safety and Risk Management…………..……………..………………….27 C. Weather………………………………………………………………………….…..29 D. Travel Insurance……………………………………………………………………29 E. Exercise Handouts……………………………………………………………...….30 F. Language……………………………………………………………………………31 G. Food Allergy Printable Cards ……………………………………………………..31 H. Smart Phone Applications………………………………...……………………….31 I. Flights…………………………………………………………..…………………...32

VIII. Preparing for a New Beginning………………………………………..……………….32 IX. Appendix……………………………………………………………………....…………...36

A. Appendix A: Spanish……………………………………………………………....37 B. Appendix B: Chinese (Mandarin).…………………………………...……………42 C. Appendix C: French Creole…………………………………………...…………..47 D. Appendix D: Portugese…………………………………………………………….52 E. Appendix E: Swahili………………………………………………………………..58 F. Appendix F: French………………………………………………………………...64

X. Meet your Contributors/Editors……………………...…………………………………69 XI. Special Thanks……………………………………...……………………………...……...75 XII. References………………………………………………..………………………………..77

2

Dear Interested PT/PTA Student, We are excited about your interest in exploring the role of physical therapy in global health! The Global Outreach Project Committee (GOPC)- formally the Global Health Project Committee (GHPC)- functions under the American Physical Therapy Association (APTA) Student Assembly Board of Directors. Through the combined efforts of the members of the 2015 GHPC and the 2016 GOPC, we have produced this updated manual to be a resource for students interested in pursuing international service. We believe that service to another community is an excellent opportunity to utilize the skills you have attained in the classroom and in the clinic while immersing yourself in another culture and expanding your worldview. This updated version of the International Service Manual for Students is a compilation of literature on international service along with our experiences and recommended resources to help prepare you for your journey. Taking interest in an international service trip is the first step, but execution requires significant planning. Our intent is to provide a summary of the current literature to help you to understand the cultural and ethical considerations of international service trips, as well as to provide resources to help you to prepare for all of the challenges and joys that lie ahead. Other resources may be available, and we encourage you to reach out to the members of our project committee and to engage with the Health Policy and Administration The Catalyst’s (HPA The Catalyst) Global Health Special Interest Group (GHSIG) through membership in the HPA The Catalyst Section of the APTA as well as through social media via Facebook and Twitter. Serving and learning abroad can provide unmatched opportunities to grow personally and professionally while meeting unmet health needs in a new community. We look forward to hearing from you as you embark on your journey! Sincerely, Christina Machaby Lee, SPT 2016 Global Outreach Project Committee Chair APTA Student Assembly aptasa.gopc@gmail.com April Fajardo, PT, DPT & Josh Greensweig, SPT 2015 Global Health Project Committee Co-Chairs APTA Student Assembly

3

I. VISION AND MISSION STATEMENT The Global Outreach Project Committee has created this Manual as a resource to help PT and PTA students prepare for service trips abroad. As interest and participation in International Service has increased in recent years, we saw a need for a compilation of resources aimed at helping students achieve the most productive and meaningful service trips possible. The purpose of this guide is to help physical therapy and physical therapist assistant students select and prepare for sustainable and ethical service experiences abroad. We hope our summary current literature, resources and personal experiences related to international service in physical therapy and health will equip students with an understanding of the cultural and ethical dimensions of international service trips. It is our vision that this guide will help prepare students for both the challenging and fulfilling experiences involved in international service. However, this manual is intended to be a starting point; students should seek additional resources related to their type of service trip, country of service, host community, host organization, and more. It is our intention that this manual will be updated annually to provide the most up-to-date resources available. II. OPERATIONAL DEFINITIONS: International Service is a broad topic which encompasses many different types of service experiences abroad. Because international service and global health are broad and ever evolving fields, comprised of many viewpoints and possible definitions, this section briefly defines some of the terminology related to international service specific to their use in this manual. Global Health: Global Health is a broad term that defines an area for study, research, and practice that places priority on improving health and achieving equity in health for all people in all parts of the world, 1 taking into account political, social, economic, and biomedical influences on health. 2 International Service: International service is a general term referring to any service or aid activities performed by students and/or organizations individually or as a part of a group, with the purpose of providing direct care, education, training, or any type of assistance aimed at allocating services to individuals in a community abroad. While PT and PTA students can benefit from participating in any type of International Service, this manual primarily discusses physical therapy and health-related service experiences. Common types of international service include (among others):

4

● International Service Learning: International Service Learning (ISL) is a specific type of international service in which a credit-bearing structured learning experience associated with an institution of higher learning is combined with community service. 3,4 ISL emphasizes active and engaged learning with the goal of fostering social responsibility, and occurs outside of the country where the students’ educational program is located. 3

● Short Term Medical Missions: Medical Missions describe a type of international medical service in which a group of healthcare professionals, typically from a higher-income country, travel to a lower income foreign country for the purpose of providing direct medical services or undertaking a special project related to health, for a short-term duration. 5

Host Country: The country to which you travel for your service trip. Host Community: The group of individuals in the village, town, city or region in which you are serving. Host Organization: The organization or program located in your host community that is coordinating your work, connecting you with the local community and/or assisting in the delivery of care or resources. The host organization may also be involved in procuring local housing, providing translation and training, and providing information about local culture and language. A host organization may be a local hospital, health center, non-governmental organization (NGO), school or church among others. Sending Organization/Sending Institution: The organization or program, typically located in your home country, that is sending you to your community of service. This organization is typically in charge of coordinating the group of volunteers prior to and often during the trip, arranging communication and collaboration with a host organization, determining your role as the student/volunteer and/or selecting service projects. The sending organization is often involved in helping you to make travel arrangements, ensure proper medical screening and vaccinations and provide resources on culture and language. The sending institution may be your school, your academic program, a non-governmental organization (NGO), church group, or US-based hospital among others.

5

III. POTENTIAL IMPACTS OF INTERNATIONAL SERVICE If you are considering serving on an international service trip, you have likely already considered many of the potential impacts your service could have on those in the community in which you will serve, as well as on yourself both personally and professionally. In this section, we will guide you through some of the potential impacts of international service on students and communities that have been identified in the literature, which you may or may not have already considered. This way you can be as prepared as possible for the joys and challenges that lie ahead. International service opportunities have tremendous potential to benefit students, professionals, and the communities in which we serve. In order to have the most positive and impactful service trip abroad, it is important to consider all of the potential impacts, both positive and negative, of international service. This way you can maximize the benefits and minimize any negative impacts through thoughtful preparation. A. Potential Impacts on Students: Potential Benefits for Students: The benefits students may experience through international service both personally and professionally are potentially limitless. Two of the most commonly perceived benefits reported in the literature of international service for students are:

● The development of cross-cultural competence 6

● The positive effects of international service on student and professional development 6

However, the potential impacts of international servic e on students are much broader than these two categories alone. We have chosen to discuss some of the key potential benefits in the context of 5 categories proposed by Hoppes et. al. 7 that summarize the impact of international service on student learning experiences:

● Building lasting relationships with patients, community members and colleagues, while enhancing leadership and problem-solving skills 7

○ International service enhances student opportunities to serve patients, and populations not usually encountered in the classroom, traditional clinical setting, or clinical coursework. 7,8

○ Students may experience leadership roles in program planning and interactions with patients and facilities.

6

○ Students’ problem-solving skills may be particularly challenged in resource limited settings 7, facilitating higher level thinking, cultural sensitivity, and interdisciplinary collaboration. 8

● Applying what is learned in the classroom to diverse community settings ○ Cultural immersion forces students to face complex questions concerning

discrimination in distribution of healthcare resources and how to best prepare patients to live and function in their environment. 7

○ Students move beyond trying to find easy fixes to a problem, to using complex clinical reasoning to find unique solutions utilizing the resources available in the community. 7

○ International service facilitates attainment of key competencies such as communication, patient education, recognizing individual and cultural differences, prevention and wellness, professional behavior and development, and social responsibility. 8

● Self-reflection skills are developed before, during and after an international service experience

○ Students are forced to reflect upon: ■ What would it be like to provide services in the host community? 7 ■ What did I experience during my community service experience? 7 ■ What was the impact of these experiences on my practice of

Physical Therapy? 7 ○ The ability to self-reflect may help build clinical reasoning skills. 7,8 ○ A formal reflection or evaluation process is highly recommended

post-experience. See Section VIII. Preparing for a New Beginning for reflection prompts.

● Opportunity to experience diversity and learn to thrive in new and diverse environments

○ International service lowers the barriers between students and the world around them. 7

○ Students experience a new community from within. 7 ○ Leaving the tight-knit social circle of their school or home community, the

student is able to interact with people from other backgrounds and communities and shift their perspective and perception of their role in the world and scope of practice in PT. 7.8

● Learning to listen to the community’s voice and hearing the unique perspectives of individuals

○ Students learn to understand individuals in varied aspects and contexts, engaged in their everyday life. 7

7

○ Students gain appreciation for the complexity of different patients and communities, and gain a deeper understanding of how to apply individualized treatment to make therapy successful. 7

Potential Challenges for Students:

While there is a vast array of potential benefits students may experience as a result of embarking on an international service trip, there are also some potential challenges that have been identified in the literature that you should be aware of:

● Students may experience anxiety related to worries about not having adequate expertise or resources to address the needs of the host community. 9 Seeing the wide array of needs in a resource-limited community may leave students feeling that they are not adequately skilled or prepared to meet these needs. 10 Furthermore, students may be asked to practice outside of their scope or to perform duties that are outside of the scope of their host organization which may leave them feeling guilty, anxious or disheartened. Students may also experience anxiety related to feeling unprepared to work and stay in a new community with cultural, economic and living conditions different from those they are used to at home.

○ Guidance as to how to handle these types of situations from professors, host community members, other students and your host organization may help to reduce this anxiety. 9

○ Doing as much research as possible before you depart about the local culture, economy and health needs may help you feel more prepared.

○ Clearly understanding the specific role you are expected to fulfill in the community and accepting ahead of time that you will likely not be able to meet all of the needs you are asked to fulfill based on training, resources or time may help mitigate some of this anxiety as well.

● Students may also experience significant emotional distress before, during or after their trip.

○ Students may be exposed to families and individuals living in extreme poverty, without access to clean water, medical care, sanitation and/or education. This can result in students feeling depressed, overwhelmed, guilty and powerless among many other emotions. 10

■ Recognizing that these are normal, acceptable emotions and having a plan in place to help you cope with these challenges may help.

● Prior to you trip, reflect upon and identify the coping strategies you typically use in everyday life and determine

8

ways in which you can utilize these or other strategies while serving abroad.

○ These strategies may include journaling, exercising, meditating and talking with friends and family members among many others.

○ Talk with your sending institution ahead of time to determine if you will be able to utilize your preferred strategies (for example if there will be techinical, weather related or cultural barriers preventing you from utilizing certain strategies) and have a plan in place for alternative coping strategies.

○ The often chaotic and busy schedules required of students during an international service trip may leave many feeling emotionally and physically fatigued. 9

○ Living and serving in a community in which cultural values are markedly different, especially if personal privacy and personal space are not as valued as they are in the United States, may leave students feeling irritated, overwhelmed or emotionally strained if they do not have the opportunity to have much time allotted to personal reflection, relaxation and privacy. 9

● Students may experience health issues when traveling to foreign countries, most commonly including gastrointestinal distress or infections and respiratory infections.

Studies indicate that students overwhelmingly report that the benefits they experienced during a service trip abroad outweigh any negative consequences they experience as a result of international service. 9,10 Nonetheless, it is important to be aware of these potential challenges in order to be as prepared as possible to recognize, address and cope with them should they arise. You may consider talking with students or volunteers who have previously served with the organization you are considering to learn about their experiences and challenges and what coping mechanisms they used to deal with these challenges.

B. Potential Impacts on Host Communities:

Much like the potential benefits to students, the potential benefits of international service to members of host communities are vast. However the current research on benefits to the host community is limited, as most of the current literature on students’ international

9

service primarily focuses on the measurement of student learning. 8 This lack of research is due to multiple factors, including:

● Language barriers, which may impair the ability to receive accurate feedback from the host community.

● Lack of sufficent feedback from host communities, as community members may be reluctant to give negative feedback to the sending program in fear that they will damage the relationship or lose access to donations and equipment. 11

Due to the limited research that is currently available on the impacts of international service on the host community, we are unable to provide a thorough assessment of all of these potential impacts at this time. However, there are studies describing individual international service and local service learning experiences, which have sought to gather information about the impacts of these experiences on communities. We discuss some of these studies exploring impacts to communities below to help you assess the ways in which you may potentially impact your host community during your international service trip. Potential benefits to host communities:

● In a study conducted by Atuyambe et al.,12 researchers evaluated the efficacy of a community-based education and health program involving student volunteers in Uganda. They found that in general, the students contributed positively to the health care being delivered and that the community members expressed appreciation for their services.

○ Students were described as compassionate, readily available and active participants in patient care who shared their knowledge and skills, and whose work ethics were inspirational to local health workers. 12

■ Student volunteers were at times able to provide care that is not otherwise readily available in the community

○ Community members reported that the regular staff members were influenced by the students to become more committed and demonstrated better time management skills. 12

○ Host community staff reported feeling encouraged by students to research new information in order for them to be able to provide better care to their patients.12

● In evaluating a domestic service learning experience, Ross and colleagues 13 documented the reported community benefits from student service.

○ Community members reported that the students were able to provide one-on-one care to patients that made them feel important. This

10

one-on-one time also allowed staff members to perform other work that they otherwise wouldn’t have had time to complete. 13

○ Community members also benefited when students brought new ideas that assisted with coming up with solutions to problems they had long been struggling to solve. 13

Potential challenges for host communities: Although there are clearly numerous potential benefits to host communities when students choose to serve abroad, there are also negative consequences that these communities may experience that should be considered when selecting a program and informing how students interact with their host community.

● In the study discussed above by Atuyambe and colleagues, 12 some of the host community staff members reported that the students’ presence resulted in extra work since they needed to be supervised. Other staff members felt that they were less time efficient when working with patients because they had to slow down to explain the process to the students as they were providing care. Additionally, some of the patients did not want to be treated by students because they felt that the students were not qualified enough to be providing quality care. 12

● Host communities may feel inconvenienced or overburdened by needing to provide additional assistance to students serving on an international service experience, including housing, meals, translation, transportation and other services.

● Students may be unfamiliar with how care is provided in a resource limited setting.

● Host community staff may take advantage of having a student present and not provide adequate supervision resulting in the patient being left with a less trained student who is not as familiar with the local healthcare system, common diseases and treatment strategies.

● The local staff members may be diverted from their normal job duties if they are needed to provide translation services for students and patients.

● It may be challenging for host communities to replace the services provided by students after they leave.11

● If organizations or programs are providing material resources, it may be challenging for host communities to continue to provide these materials once service trips are over.

11

○ Furthermore, the economy of the host community may suffer if materials are purchased in the United States and brought by students, as local people may no longer purchase these products from local vendors.

While it may be discouraging to read about potential negative impacts of your service on your host-community, the good news is that with proper planning, these potential negative impacts of international service can be monimized via a multitude of strategies. These include:

● Reducing the risk of cultural misunderstandings, by ensuring that you have a thorough cultural competency training prior to the international service experience. This could include education on the history, politics, and economics of the country along with training on cultural communication and the healthcare beliefs and practices in the host community.

● Creating a mutually beneficial international service experience for all parties involved via a comprehensive assessment in which the sending organization, the student, the host community, and the patients all evaluate their experiences as well as the community’s needs and resources. 8 (See section V.B on Community Needs Assessment and Community Engagement for more information ).

● Avoiding problems posed by language barriers by having at least a basic understanding of the language including key words and phrases that will be utilized during the international service trip. It will improve the experience for students, patients, and the host community staff. (Please see Section IX. Appendix for language appendices to get started with some common languages) .

As you can see, future research is still required to further evaluate the impacts of international service on host communities. But we do know that with proper planning and cultural awareness, we can strive towards having as positive an impact on our host communities as possible. There are a plethora of benefits that host communities may receive from international service, but also some negative effects. It is critical that both students and sending institutions are familiar with these implications and utilize strategies to minimize the disadvantages and maximize the benefits for the host communities.

IV. ETHICAL CONSIDERATIONS OF INTERNATIONAL SERVICE Before you embark on the next step of selecting the right international service opportunity for you, it is important to reflect on some of the ethical considerations involved in this type of work. While international service has the potential to be transformative for both students and host communities, ethical considerations must be

12

addressed to ensure the experience is as positive as possible for all parties involved. Here are some ethical concerns you should consider as you research programs and choose the one that is best for you:

● Ensure you have adequate supervision and mentorship throughout your experience.14 Recognize that as a student, you may lack clinical experience and may be at a disadvantage in your new setting. 11,15 Always ensure that you practice within your scope to avoid compromising your safety, and that of the patient and community. Never practice in a way that makes you uncomfortable. Make sure to know who to speak to ahead of time in case you observe unethical behavior or exploitation.

● Recognize the importance of mutual and reciprocal benefit. Understand your role and constantly consider the benefit and any potential harm you may provide to the host community. (Refer to section III.B Potential Impacts on Communities) . Prioritize the needs of the patient and community above your own. Your goals and values should be aligned with those of the community. 15 Check if your program conducts a community needs assessment to ensure that the program’s goals and mission align with the goals and needs of the community. 8 (Refer to Section V. B Needs Assessment and Community Engagement ).

● Self-reflect, build your understanding, and ensure your motive is to serve.

Consider the host institution’s / sending institution’s / community’s investment of resources and trust in you. While an international service trip is a wonderful opportunity for you to learn and serve, it is also an opportunity for the other parties involved. Your motivation should not be solely to tour or build your resume (though these are some potential benefits), but to serve the needs of the host community.

○ Remember that while abroad you are a representative of your school, your profession, and your country. Be aware of your unique privilege as a highly educated individual and display humility. 15 It will be beneficial to have an understanding of historical, political, or socioeconomic factors that have influenced or created social inequality and vulnerability within your host community.

● Develop cultural competence and cultural humility. In order to provide

culturally appropriate, sustainable care, it is important to have an understanding of the local culture such as health beliefs and communication styles. Recognize that you can never fully understand all of the nuances of any culture, including

13

your own, and that there are significant variations among individuals within a culture. Be aware of language and cultural barriers that may hinder informed consent, treatment options, or patient education. Be aware that your position as a health care provider may also be viewed as an authority not to be questioned in some cultures. Develop a working partnership with the host community and devise a plan to overcome some of these cultural and communication barriers.

● Be aware of social determinants of health. A lack of information, knowledge or

available clinicians are likely not the only factors contributing to a health problem or health behaviors. Social determinants of health play an important role in influencing health and behavior. Social determinants refer to the social factors that influence health decisions which include the conditions in which people are born, grow, work, and live, and the broader forces influencing daily life such as economic, social and political policies and systems, development agendas and social norms among others. 16 Recognizing social determinants means recognizing that people are not necessarily choosing unhealthy behaviors due to lack of education, motivation, or resources, but that there is a deeply embedded and complex system of determinants influencing these behaviors.

○ Providing education and clinical care may not be sufficient alone to address a health problem or influence health behaviors.

○ Collaborating with or referring people in your host community to Non-Governmental Organizations (NGOs) or community action groups that address specific social determinants may help your intervention be more effective.9 These collaborations may include (among many others) connecting with organizations focused on:

■ Income-generating activities and occupational training ■ Gender equality ■ Labor rights and employment conditions ■ Education ■ Sanitation ■ Infrastructure

○ Working with an organization that has performed a thorough needs assessment can help recognize the social determinants impacting health behaviors and problems in your target community. 16 (See section V.B Community Needs Assessments and Community Engagement)

● Recognize that everyone has a right to privacy. Following your trip, you may

want to share pictures and stories about your journey. However, you must be sure to do so ethically. Everyone has the right to privacy and, while you will want

14

to share your experiences and be a champion for your community, your patients’ and colleagues’ privacy rights should come first! We highly suggest holding yourself accountable to HIPAA regulations even when you are practicing in countries where you may not be legally bound to these laws. Ask yourself: If I were practicing in the United States, would I share stories or photos of my patients without their permission? The answer is hopefully no, and it should apply to your patients internationally as well.

○ Your stories and photos should empower the members of your host community and shine a light on their strength and resiliency, rather than paint them as helpless or disenfranchised.

○ Be sure to get the consent of your colleagues and/or patients before sharing stories, pictures or videos. However, you must be aware that individuals or patients may feel obliged to comply with your request, for fear they may not receive services if they refuse, even if you have the best of intentions. Be sure to ask a community leader or your program director how to proceed with requests to take photos. The program may have a policy already in place for these situations.

○ Depending on the country you are visiting, taking and sharing pictures may hold even larger consequences. Careful consideration is required and special permission must be obtained to take photos in places of conflict, political unrest, corruption, ethnic tensions or other discrimination that may put you and your patients or collegues at risk

■ For example, photos posted online of patients or colleagues in a refugee camp or area of conflict could be used by terrorists or other groups to locate and target these groups or individuals

○ If you are still unsure why a photo policy may be in place, we encourage you to ask your program director or sending and host organization leadership about their photo policy and the cultural implications behind taking photographs.

Other ethical considerations during your trip should include:

● View cultural differences as an opportunity to consider a condition and potential treatment from a new perspective, instead of a barrier.

● Consider how your actions are perceived in the community and be careful to avoid situations that reinforce systemic poverty, or racist and colonial relationships.

● You may need to be an advocate for your patients on social justice issues that influence safety, healthcare, and quality of life, but do so within culturally appropriate and sensitive boundaries. 15

15

Do you want to learn more? Consider partaking in the Unite for Sight Modules on cultural competency and ethical photography, and the World Health Organization’s (WHO) module on social determinants of health: http://www.uniteforsight.org/cultural-competency/ http://www.uniteforsight.org/global-health-university/photography-ethics http://www.who.int/social_determinants/tools/en/ V. CHOOSING THE RIGHT PROGRAM Once you have considered both the potential impacts of international service on yourself and your host community as well as the ethical implications of service abroad, you are ready to take the next step in choosing a program that will fit your needs and help you serve and learn abroad in an ethical manner. Choosing the right program is essential to your experience. The following are crucial points to consider in selecting the right program. A. Sustainability One of the most important aspects to consider when selecting a service opportunity is finding a program that has an operational model based on developing sustainability. 6,17 Sustainability in general is defined as the ability to continue a defined behavior indefinitely. However, in practice it is much more complex. While sustainability in global health was historically defined as a program’s ability to continue to function and provide services in a community for the long term, many experts now define it based on the programs’ ability to foster the long term adoption of health and health behaviors, beyond the time frame in which the organization is operating in the host community. 17 Additionally, many experts describe sustainability in global health asmulti-dimensional, comprised of at least 2 factors: 1) sustaining health, and 2) sustaining the health promoting activities of an organization or group. 17 Thus sustainable programs should aim to sustain health in a community by both providing high quality healthcare when appropriate and working to sustain the target activities by empowering local people to continue these health promoting activities on their own, without the help of foreign organizations. The ability to sustain community benefits beyond the short time period of your trip should be one of the most important aspects to keep in mind when searching for a

16

sending organization or program. If health services or behavior changes cannot continue beyond the period of your trip, then your potential to have a lasting, positive impact on your community will be limited. Achieving sustainability can take many shapes, but often includes an educational or training component aimed at training and empowering local community members and/or health care providers to take over the provision of services you are providing during your trip. It may also focus on empowering local people to generate income or form partnerships with other organizations to continue to procure resources on their own once the service trip (or series of trips) is over.6,18 While achieving sustainability can be a slow process, often requiring an organization to make many service trips to a given host community over time, sustainability should be the ultimate goal. This goal of empowering local people and communities with the skills and resources to meet their own needs, may be achieved in multiple ways including:

● Working with an organization that primarily focuses on education and training

● Working with an organization that continually sends resources, volunteers and educators to an area until self-sufficiency is achieved 6,17

While most students are not involved in the development of programming for their international service trips, understanding how to develop a sustainable program and why it is important is essential to choosing an organization that fosters sustainability.

● Why is sustainability important? ○ Sustainability is crucial to serving in a way that provides lasting, positive

benefits to a community. While a short term project without a long term sustainable plan may provide some immediate benefits, without continued resources (in the form of volunteers, material goods or educational services) the benefits of your service are unlikely to be maintained. Because it is unlikely (and potentially harmful) that foreign aid can be sustained indefinitely, finding an organization that focuses on systematically empowering local people to meet their own needs is critical. Furthermore, a lack of sustainability can be detrimental leaving the community worse off than they were prior to the service experience, as a non-sustainable model can create dependance on foreign aid. 17

● How can you ensure that the program you are considering is fostering sustainability?

○ Inquire as to whether the organization has identified and addressed the specific needs of the community- This can be achieved via a thorough community needs assessment (see section V.B Needs Assessment and

17

Community Engagement) . Additionally as a part of your international service trip, talk with local people to learn from their perspectives and knowledge about what they feel they need.

■ If you base your service activities on needs identified by members of your host community and utilize local knowledge and skills to help solve problems identified, you are more likely to work towards developing a sustainable program.

○ Collaborate with local physical therapists, health care providers and physical therapy organizations when possible.

■ If there are physical therapists in your host community, ideally they should be involved in the service project so that they can be trained to take over the provision of care. Furthermore they can help develop and implement programs that are most appropriate for the local healthcare system and culture.

● If physical therapists are not available in your host community, collaborating with other healthcare providers is an excellent way to integrate your program into the existing health system.

■ The World Confederation of Physical Therapy seeks to unify the Physical Therapy profession globally. Check out their website (http://www.wcpt.org) and get in contact with the WCPT Participating PT Organizations to see if there are any operating near your host community. You may be able to connect your host community to a WCPT Participating PT Organizations to further build their capacity.

○ Identify programs or sending organizations which help promote the key components of a sustainable health system.

■ Recent surveys and studies have identified a series of key factors for fostering sustainability. 18,19 These recommendations suggest that sustainability can be best achieved when we collaborate not only with local health care providers, but with local policyholders and laypersons as well. These studies identified the following recommendations:

● Involve members of the community who would directly benefit from the services to be provided in planning and developing a program. 18

● Collect health statistics pre and post intervention/programming to justify whether further support of these programs and policies in the host community is

18

warranted, or whether the plan should be adjusted or changed. 18

● Conduct regular monitoring and evaluation processes. 18

● Promote equitable and accessible services available to all interested members of the target community. 18

● Create programs that fit into the established health care system in the host community, so that this program may be more readily institutionalized by the existing providers, if applicable in the setting. 18

● Assess knowledge and skills and and provide training for local healthcare providers. 19

● Plan ahead for the challenges of working in a setting that may have poor infrastructure and/or communication systems by having plans in place to reach all subgroups of a community.19

○ While all of these factors may not be applicable in each environment where you may travel and serve, they provide a solid framework of goals to consider when trying to achieve a sustainable system.

○ Even though you as the student will likely not be involved in developing the framework of a program to ensure its sustainability, it is important for you to understand the components of a sustainable system so that you can search for and choose programs that aim to foster true sustainability.

How can you ensure that the organization or program you are considering is striving towards developing sustainability? Consider posing the following questions (among others) to the program or organization you are considering:

● How often are groups sent into the community for service trips? ● Is there a plan in place to decrease the requirement for volunteers by

transitioning the provision of care or resources from foreign volunteers to members of the host community?

● Is there an educational component for members of the host community? ● Has a formal needs assessment been completed to identify the biggest needs in

the community? ○ Have members of the host community ben engaged in identifying ways to

meet these needs? ● Are tangible resources (medical supplies, food, etc) being brought in by this

international service organization?

19

○ If so, how will the members of the host community continue to procure these resources once the service trip is over?

○ Are these resources being purchased locally when possible (to support the local economy) or are they being brought in from abroad?

B. Community Needs Assessment and Community Engagement When selecting an international service experience, another crucial factor to consider is the level to which the organization you are considering has incorporated the needs, skills and resources of the host community into their organizational model. This is very closely related to sustainability ( See section V.A Sustainability) . In order to assess whether the organization you are considering has taken these factors into account, it is important to find out if the organization has performed a community needs assessment or community appraisal . Recent studies have suggested growing concern that international service experiences may have negative impacts on both host communities and students if the needs and wants of the communities are not fully assessed and taken into account prior to initiating programming. 20,21 These can include wasting valuable time and resources on programs that are not appropriate for the health needs and beliefs of the target population among others ( See section III.B Potential Impacts on Communities ). The good news is that these potential negative consequences can be minimized, if community needs assessments are performed prior to initiating projects or providing services. While most students embarking on international service trips will not be performing needs assessments themselves, as these are typically performed by staff in the organization or institution you are traveling with, it is important for all students to understand how and why they are performed in order to ensure that the organization has thoroughly considered the needs of the community before selecting an international service program.

● Needs assessments are systematic approaches of studying a host community to garner a thorough understanding of the community's health problems and the myriad factors affecting the health problems identified, including social determinants of health. 22

● There are numerous models of needs assessment used in global health. Some of the more common methods used include the precede-proceed model 22 and Life Cycle model among many others. 23

● The various models used for needs assessments are all designed to seek information about health and health behaviors within a community in order to not

20

only empower local communities to participate in health planning and initiatives, but to provide students and health professionals with an opportunity to have a much deeper understanding of all of the factors that contribute to the health problem so that they can provide the best services possible. 23,24

● Organizations should use the information collected in community appraisals and needs assessments to develop appropriate and sustainable programs in partnership with the community to provide as productive an experience as possible for both students and members of local communities. 24

How can you ensure that the organization or program you are considering has performed a thorough and appropriate community needs assessment? Consider posing the following questions to the program or organization you are considering:

● What are the ethical goals of your organization while providing these services? ○ The organization should have goals regarding minimizing exploitation of

the local people and community, among others. Goals may include increasing likelihood of long-term impact, transitioning the provision of care and services to local partners, demonstrating awareness of cultural differences and minimizing community disruption. 25

● Do you have information from interviews or surveys of the local community to

identify their perspectives of their own health concerns and needs? Is that information used to shape your community interventions?

○ These forms of outcome measures emphasize the needs and concerns of the community in planning the organization’s services. This is a critical step for not only gathering objective information and providing a baseline of health status, but also to establish rapport with local individuals and emphasize their role in determining the needs of their own community. 20,21

● Does your organization utilize a participatory research approach?

○ This identifies the style of information gathering throughout the course of the organization’s stay in a host community (and is applicable to decision-making whether or not formal “research” is conducted). Participatory research involves community members at every stage of the process, including modifications to a program to meet the changing needs of a community. 20

● How do you measure the success of your organization?

21

○ Again, success should be defined by the community’s goals and concerns, not only those identified by the organization. There should also likely be a goal concerning the successful training and education of local providers in order to turn the project over to the community healthcare providers. Ideally, goals would be identified from the beginning of the project as clear, concise and measurable objectives of the project.

● Are local leaders, administrators, and/or healthcare providers involved in the

services of your organization? Are they readily available to discuss and approve the goals of your organization’s efforts?

○ Communities are more likely to support the efforts of an organization that adopts the concerns of the community rather than creating their own agenda. Involvement of leaders or healthcare providers allows for local insight into the individual projects of the organization and promotes sustainability of the project once the organization leaves. 20,21

Community appraisals and needs assessments play an important role in ensuring that international service opportunities engage the local community in identifying and solving local health problems. International service has tremendous potential to be mutually beneficial to both students and local communities. 21,26 However, without engaging members of the host community in the development of a physical therapy program or intervention, key needs, desires and cultural beliefs associated with with the health problem may be missed. 21 As a student you will have the best experience if your host community is engaged and excited about the work you are doing together! Some other questions you or the organization may consider asking the people in the host community are:

● What is your perspective on the health of your community? ● What are some of the factors affecting people’s health (good and bad)? ● What would you change about your community’s health? ● What are the pros/cons of the healthcare you receive now? ● Who else do you think I should speak to?

22

C. Other Considerations Once you have found a program that is focused on developing sustainability and has appropriately engaged local communities, there are several other very important factors you should consider before you choose a program:

● Language ○ When selecting a country of service, research the country’s primary

language. ○ If you’re interested in learning or already have a foundation of knowledge

in a specific language, you might consider service in a country where you can further develop these language skills.

■ If you plan to serve in a country where you do not speak the language, it is paramount that you have a commitment to developing at least a basic level of understanding of the local language prior to your departure.

■ It may be helpful to have a cheat sheet of common phrases you are likely to use throughout your trip.

● However to form truly meaningful relationships and better understand the needs and beliefs of your patients, we strongly encourage you to have more than a basic understanding of the language spoken in your host community.

● You can refer to the language appendices included in this manual for help getting started with several common languages ( See Section XI Appendix)

○ If you are planning to serve somewhere where you do not speak the local language, it is crucial to inquire as to whether or not the program has interpreters or interpretation services available

■ Most established international service programs have interpreters available to assist you

● Crime and Safety

○ It’s critical to be aware of the political climate of a country and region before you make your decision. The US Department of State for Alerts and Warnings provides the most recent information regarding issues that may be a cause for concern when traveling to a specific country such as drug wars, terrorist threats, political instability, etc.

23

○ Speak with faculty or staff from your sending institution as well as members of your local community to learn about common safety concerns including local crime and ways in which foreigners may be targeted in a specific community.

● Interdisciplinary Team vs. Physical Therapy Team

○ You may have the option to choose between serving on an interdisciplinary team comprised of healthcare professionals from a variety of disciplines, or a team mainly comprised of PTs, PTAs and associated students. There are fantastic benefits associated with both options. Sometimes it just comes down to timing and availability of programs.

■ Interdisciplinary Team: ● Serving on an interdisciplinary team allows you the

opportunity to educate other health professionals about the scope of physical therapy, while learning about the scope of other health professionals.

● Just like in healthcare in the US, the range of impairments and pathologies you may be exposed to during an international service trip is vast. At times, you may encounter a patient presentation, condition or pathology with which you are unfamiliar. Being part of an interdisciplinary team could allow you to collaborate with an occupational therapist, speech- language pathologist, nurse, optometrist, psychologist, physician, dentist, or other healthcare provider to help solve complex problems.

■ Physical Therapy Team: ● Working on a team of physical therapists and physical

therapist assistants affords you the manpower to divide and conquer. Subgroups and/or specialists can provide screenings in specialty areas such as pediatrics, orthopedics, neurologic, and wound care. Furthermore, working closely with physical therapy professionals and students can provide excellent networking opportunities.

● Finding international service programs

○ Global Outreach Project Committee (GOPC) Database ■ The GOPC has compiled a database of programs that currently

provide opportunities for students to serve on both domestic and international service trips. Most of these programs are associated

24

with universities, but there are some NGOs and community groups included as well. Some of these schools listed have established their own programs while others partner with outside organizations. The database also includes information as to whether the programs accept students from other DPT/PTA programs. This list is non-comprehensive and we encourage you to search our other opportunities as well.

○ Global Health Special Interest Group (GHSIG) ■ Become a member of the HPA the Catalyst’s GHSIG. For additional

resources, you can check out the website and join the listserv. ○ Combined Sections Meeting (CSM) Global Health Reception

■ Each year, HPA the Catalyst’s Global Health Special Interest Group (GHSIG) sponsors a reception at CSM in which schools, organizations, professionals, professors and students with a global health interest share their purpose and experiences with attendees.

● This is a great opportunity to network and find out about international service programs

○ Utilize Social Media ■ Facebook: Join “Global Health Special Interest Group”

● Post questions, share experiences and engage with like-minded students and clinicians.

■ Twitter: Follow @aptaGHSIG ● Receive updates on global health issues or ask a question. ● Follow #globalPTconnect or #globalhealthPT for

conversations aimed at uniting physical therapy on an international level to enhance practice, application, and introspection.

VI. FINANCING YOUR TRIP: Money can be a major obstacle to setting plans in motion for an international service trip. Hopefully, this financial section of the manual will help to make that challenge a little less foreboding by providing advice and information regarding budgets, fundraising, and scholarships.

● Budgeting your Trip Here are some potential costs to consider when creating a budget for a service trip. Significant research is required, and expenses will vary widely depending on

25

the destination, length of stay, and supplies needed. Some of the costs listed below may not apply to every traveler or trip.

○ Potential Costs ■ Airfare ■ Housing ■ Meals ■ Partner Company/Guide Fees ■ Transportation (to and from airports and on-site ground

transportation) ■ Travel Insurance ■ Passports ■ Visas* ■ Vaccinations* ■ ATM/Currency exchange fees ■ Activity fees (for when you aren’t working!) ■ Tips for services ■ International phone plan ■ Medical supplies

*For more information, visit wwwnc.cdc.gov/travel and choose your destination country from the drop-down menu. Check “mission/disaster relief” and click Go.

● Raising Funds

Some sending or host organizations may be able to help you find funding and provide advice for planning your budget. However, the responsibility of obtaining funds for a trip is in the hands of the traveler, so creative outreach is often your best bet for successful fundraising.

○ Marketing ■ Create fliers for handing out at schools or local events, health fairs,

etc. ○ Writing a formal letter to distribute to friends, family and your local

community ■ Provide details regarding where you are going, your mission

statement or goals, the mission of the sending and host organizations, why you feel compelled to take this trip, how you plan to raise funds in other ways, and how their contribution will make your trip possible.

○ Crowdfunding through sites like GoFundMe or Volunteer Forever ○ Fundraisers with minimal required initial investment

26

■ For example: Plan a 5K, dinner or bake sale with food donations from classmates/professors/friends/family, talent shows, silent auctions or T-shirt sales

■ Fundraising through the organization with which you are partnering ■ Plan a “Benefit Night” at restaurants or concession stands that will

donate a portion of the proceeds to your service trip ● If you are traveling with an organization that is registered as a 501(c)(3) nonprofit

organization and the organization can provide a specific fund for your service trip, donors can give directly to the organization and write it off as a charitable donation on their tax returns.

● Scholarships

Unfortunately, scholarships for international service trips are not plentiful. Check with your school, your specific program, and/or your local community to see if grants and scholarships for international service trips are available. These websites may provide opportunities for scholarships for healthcare-related service trips:

○ Do Something ■ This website offers funding and scholarships to applicants under 26

years of age who have a vision for a way to help the world in a variety of ways

○ Robert Wood Johnson Foundation (for domestic service trips only) ■ This Foundation supplies grants that support efforts to improve

domestic health care ○ Global Missions Health Conference ○ Volunteer Forever ○ DJO Global

VII. PREPARING FOR YOUR TRIP “Failing to prepare is preparing to fail.” Although you cannot possibly plan for everything, it is essential to be well-informed and to think ahead. At the top of your preparation list should be to obtain your passport, visa (if necessary), and vaccinations. These items can take months to complete and can halt your trip if you do not give yourself ample time. Save yourself some stress and make sure these are done well in advance! A. Passport/Visa The Department of State has a detailed guide on how to best obtain a passport before traveling abroad. They can also provide information about each country in the world,

27

including visa and passport requirements. Some countries require a visa for entry, while others may not. The Department of State also recommends that travelers contact the embassy of the country they plan to travel to in the USA about up-to-date time restrictions for visas.

B. Health, Safety and Risk Management Before embarking on your trip, you should utilize the following resources and tips (among others) to ensure that you are as prepared as possible for a safe and productive journey.

● Center for Disease Control and Prevention (CDC) Health Page ○ Before leaving the country one should visit the CDC traveler’s health

page. This resource contains a wealth of information that is beneficial for clinicians, students, and tourists. CDC’s Traveler’s Health Page

○ Destination list ■ Most of the countries in the world are listed in this section.

○ Medicine and Vaccination Information ■ The CDC has a list of vaccines and medications that they

recommend before visiting a particular country. They also provide a list of clinics which provide these vaccinations. It is also recommended that you set up an appointment with the travel medicine department at your local hospital.

● Link: CDC's Find a Travel Clinic ○ Health and safety

■ Find advice on what food to consume, how to properly clean and cook it to remain safe, and how to stay safe in the outdoors.

● This information can be found after selecting a country on the CDC’s Traveler’s Health Page

○ This information can also often be obtained from your host or sending organizations and from members of your host community

■ The CDC also has a detailed description on how to prevent infectious disease and motor vehicle accidents in each country in the world. Motor vehicle accidents are particularly important because this is the number one cause of death for travelers.

■ The CDC also provides a link with contact information for every embassy in the United States; a good resource for travelers who have questions about a particular country’s policies.

● Link: US Embassy Contact Information

28

○ Traveler’s Checklist ■ A comprehensive checklist for travelers to measure if they are

adequately prepared for their future travel experience. ● Link: Traveler's Checklist specific for each country

○ Smart Traveler Enrollment Program ■ This program helps Americans enroll with the US Embassy or

consulate once they have entered their destination country. This service may become necessary if you experience an emergency while traveling in a foreign country.

● Link: Smart Traveler Enrollment Program

● Registering with your school’s International Travel Registry ○ If you are traveling with a program associated with your school, check to

see if your school has an international travel registry ■ This will help your school get in contact with you in the case of an

emergency. ■ Some schools require that you register with their travel registry

before you are permitted to travel with any of their associated programs, so be sure to check about their requirements.

● Having a Formal Risk Management program in place

○ With increasing numbers of students traveling abroad, it is important to recognize the risks that may come from being in a country that is foreign to you. Risk management plans should be put into place to prepare for certain physical, emotional, financial, or reputational factors, and should include policies and procedures on how to mitigate these risk factors. The following is a non-comprehensive list of some threats that could be encountered while serving abroad:

■ Injury or illness ■ Natural disasters ■ Robberies, muggings, theft ■ Civil or political unrest ■ Kidnappings or ransoms ■ Loss of travel documents

○ While most institutions and international service programs do have formal risk management programs in place, it is important for your safety to make sure that such a plan is in place, that you are familiar with the plan, and that you comply with it. If a formal plan with the organization is not in place, you may consider serving with a different organization that does

29

have a formal plan in place to better ensure your safety. Risk management plans should include the following factors and may be more extensive depending on where you are traveling:

■ Pre-screening of students ■ Training for faculty and staff ■ Travel itineraries for students, faculty or staff ■ Emergency contact information for all involved in several formats,

including hard and electronic copies ■ Emergency health care insurance and information about nearby

medical facilities such as hospitals and pharmacies ■ Evacuation resources (including both land and air evacuation

plans) and/or insurance ■ Cultural competence training ■ Hard copies of all travel documents, credit cards, debit cards, and

insurance ■ Cell phones with international plans or short-term contracts with

local companies to provide students with a local cell phone and numbers

C. Weather

● Before visiting a new country, check weather reports about your destination in order to inform your decisions about what to pack. Weather can vary drastically based on the season so looking at the weather for the specific time during which you plan to travel is crucial. Failing to pack clothing, footwear and other items appropriate for the climate can not only result in you being less comfortable, it can put your safety at risk (overheating, dehydration, cold exposure, hypothermia ect.) If extreme weather is projected, this information is published on the Department of State and CDC’s websites.

○ See this link for more information: Natural Disasters D. Travel Insurance

● Your sending organization may or may not require that you obtain travel insurance. If it is not required, you will want to research the different types of insurance available in order to make informed decisions. Common types of insurance include:

○ Basic travel insurance: insures the financial investment of your trip. Typically covers things such as lost baggage and cancelled flights

○ Travel Medical Insurance: covers the cost of medical treatment overseas

30

○ Medical Evacuation services: provides air ambulance, medical evacuation, or escort service coverage for travelers overseas

● Where do I buy travel insurance? ○ The link below provides names of various companies across many

different states that offer insurance to travelers. ■ US Department of State Link: Travel Insurance

○ Talk to your own life insurance company if applicable. Many large life insurance companies also offer travel insurance plans.

○ Talk to the program or organization overseeing your trip. Many times the cost of the trip includes travel insurance or it can be purchased separately at an additional cost.

E. Exercise Handouts

● Patient education is an essential part of physical therapy practice. Much like in the United States, providing patients with handouts when possible can help empower them to continue making functional gains long after working with a PT or PTA.

○ Visual aids serve as a reminder about how to safely and appropriately perform the exercises as prescribed by the therapist.

○ Exercise handouts can be hard to come by in a resource-limited setting. You may need to get creative with how you administer exercise programs. These may include (among many others):

■ Drawing pictures of exercises ■ Taking photos of your patients performing their exercises (with their

consent) ○ While you may choose to come prepared with pictures of common

exercises with you, it is often more effective to use photos or drawings done locally to ensure that they are culturally appropriate.

○ Remember to ensure that all materials are appropriate for your specific patient

■ Images should be culturally appropriate, including culturally appropriate dress, positioning and symbols

■ Any written instructions should take into account the language and literacy level of the patient

31

F. Language Prepare as much as possible by becoming familiar with your host community’s local language. There are many resources available. Some of these include:

● Courses: ○ APTA Spanish Course Manual

■ Earn 2.0 CEUs while learning Spanish for Physical Therapists. ■ Discounted rate is available for students and APTA members.

● Link: APTA Learning Center ● There is not currently a course scheduled, but check back

regularly for the next Spanish course! ● Applications:

○ Physical Therapy Spanish Guide ○ Canopy Medical Translator

● Language Handouts included in this Manual for commands/phrases, anatomy, and directions

○ Appendix A: Spanish ○ Appendix B: Chinese (Mandarin) ○ Appendix C: French Creole ○ Appendix D: Portuguese ○ Appendix E: Swahili ○ Appendix F: French

G. Food Allergy Translation Cards

● Traveling with specific food allergies can be very difficult. Use this link to obtain helpful food allergy translation cards.

○ Link: Food Allergy Translation Cards H. Smart Phone Applications

● Viber, WhatsApp, and GroupMe are wireless internet services available to use to keep your loved ones informed about your whereabouts through texts, calls, and pictures. As you form relationships with people internationally, these apps may also make it easier to stay connected during and after your trip.

● Google Voice: Create a FREE account to send text messages to cellphones and landlines. The recipient does not need to have this application to contact you.

● iMessage and Facetime: For iPhone and iPad users, these applications are available for international use when connected to wireless internet.

● TripAdvisor: Download a city map without wireless internet.

32

● City Maps 2Go Offline Maps: Allows you to download and use maps offline so that you can navigate in parts of the world where you can’t use your GPS

I. Flights

● Finding the most affordable flight can be a challenge. ○ Kayak and Skyscanner are search engines that compare airfares across

different providers ○ Fly for Good finds humanitarian discounted airfare for groups and/or

allows crowdfunding of airfare. VIII. PREPARING FOR A NEW BEGINNING: Students are often well prepared for an international service trip, but many are often surprised to find how ill-prepared they are to cope with the reality of such a life-changing experience upon their return home. When you build lasting ties with your host community, you may be surprised to find how difficult it can be to adjust to life back home. Give yourself time to adjust back to your daily life and carry the lessons you learned during your service with you everywhere you go. Hopefully you will walk away with a broader, more open-minded and more humble perspective on culture, health, health behaviors, and life in general. Upon return home, it is important to take time to reflect upon your recent experience. Many programs may have a formal evaluation process that will require you to evaluate and reflect upon your experiences, but even if yours doesn’t it can be beneficial to record the challenges and successes you experienced, what you learned, and how your experience has impacted you or your future plans. Recording your thoughts and memorable situations that show growth, problem solving, and transferable skills may be helpful when setting long term career goals or preparing for a job interview. Here is a list of questions to get you thinking:

● What were the primary objectives of the trip? ● What did you learn about the population served and the challenges they face? ● How did you partake in the local culture? ● How did this experience influence your personal and professional growth? ● What were personal challenges you faced during the experience and how did

you address them? ● What unique knowledge have you gained from this experience? ● How has the experience influenced your view of the role of PT in community

service and public health awareness/education?

33

● Are there areas of our healthcare system (local or national) which could be improved based on your reflections of your international experience?

● What tips do you have for others who may participate in this experience in the future?

Additionally, you may want to share your journey and inspire others to serve both domestically and internationally. You will likely return home wanting to help spread the word about health care disparities and what we can all do to make a difference. But, be sure to do so ethically (See section IV. Ethical Considerations of International Service ). Just as you would not want people from another culture to come into your community for a short time and tell their version of your life story, you should be careful not to be the voice of others. As stated in the ethics section, be sure to always obtain the consent of your colleagues and/or patients before sharing stories, pictures or videos.

● Social Media ○ Facebook, LinkedIn, and Twitter are great platforms on which to network

as professionals. Some popular hashtags for discussing our profession are #globalPTconnect, #SolvePT, #GetPT1st , and #ChoosePT

● Journal

○ It can be difficult to absorb the details of a life-changing trip all at once. Keeping a journal can help you relive important moments and reflect upon it at a later time. Write about the sights, the sounds, and the tastes. Discuss your frustrations, joys, failures and triumphs.

● Blog

○ Start a blog and share your experiences. Platforms such as Tumblr are FREE. Here are some of our favorite blogs:

■ PT Haven's Pulse ■ World Confederation for Physical Therapy President's Blog ■ Southwest Baptist University Global Health Outreach Program's

Blog

● Share Your Experience with US! ○ E-mail your story to The Global Outreach Project Committee

(aptasa.gopc@gmail.com ) ○ Consider submitting an article to HPA the Catalyst’s newsletter discussing

your experiences

34

○ Submit a proposal to HPA the Catalyst’s Global Health SIG to be a presenter and share your experiences and/or research findings at the Global Health Reception at the annual Combined Sections Meeting

What’s next? Now that you have navigated culture shock, reflected upon your experience, and shared your experience with others you may be wondering how you can stay involved with global health/service throughout your career as a physical therapist. Our hope is that an international service experience is more impactful than just that week or month you spent abroad. You may have developed a new passion and motivation for global service and a curiosity about new cultures and health beliefs. You may want to continue to serve on international service trips or you may decide to completely focus your career on working in resource-limited countries. Fortunately, you do not need to wait for the next international service opportunity to stay involved in global health. There are likely many opportunities to serve underserved populations in your own city or town. In addition to seeking out future opportunities to serve abroad, we hope that you will also seek out these opportunities to share and grow your service skills in your own community. This section aims to provide you with several tips and resources to pursue international or local service opportunities or get started towards a career in global health. General tips:

● Utilize many of the suggestions and resources in this manual to help find organizations that foster ethics, sustainability and community engagement

● Find an organization that matches your interests, passions, and personal mission and vision.

● Consider searching for organizations using the international term for physical therapist: “physiotherapist.”

● Send an organization you are interested in an email/cover letter/CV with what you are hoping for and what you can offer.

The following is a list of resources to explore, though we encourage you to search additional resources as well:

● https://internationalmedicalcorps.org/ International medical corps offers short (3 months) and long term (one year) paid opportunities in emergency relief.

● http://www.aptahpa.org/?page=GlobalHealthSIG The Global Health SIG of the APTA’s HPA The Catalyst section has additional resources on their website for members of the HPA The Catalyst section.

35

● http://reliefweb.int/ This website has job postings for short and long term opportunities. Available positions are always changing and are usually in an emergency relief context.

● AmeriCares: http://www.americares.org/who-we-are/jobs/ ● Handicap International: http://www.handicap-international.us/ ● VSO: https://www.vsointernational.org/volunteering ● Hearts in Motion: http://www.heartsinmotion.org/ ● Mercyships: https://www.mercyships.org/ ● Aid Jobs: http://aidjobs.org ● World Health Organization: http://www.who.int/employment/vacancies/en/ ● USAID:

http://www.usaid.gov/work-with-us/careers/vacancy-announcements?field_bureau_io_nid=All&field_career_type_value=All&field_career_eligibility_value=All&page=1

● World Confederation of Physical Therapy: http://www.wcpt.org/working-and-studying-in-another-country The WCPT also has a biennial congress in which physical therapist from all over the world convene to share and discuss ideas and research. It is the largest international gathering of physical therapists.

36

IX. Appendix

37

Appendix A: Spanish Basic Phrases:

Good Afternoon Buenas tardes

Good Evening/Night Buenas noches

Good Morning Buenos días

Have a good day. Que tengas un buen día.

Hello/Hi Hola

How are you? ¿Como estas?

How do you say this (point to something) in Spanish?

¿Cómo se dice esto (point to something) en español?

Please Por favor

Thank you Gracias

What is this? ¿Qué es esto?

What is your name? Como se llama?

Where is the bathroom?? ¿Dónde está el baño?

You are welcome. Bienvenido

38

Key Commands: Each command should be followed with please/por favor.

Bend Doble

Bend Down Agache

Breathe deeply Respire profundamente

Come here Venga aqui

Close Cierre

Do Haga

Hold (Resist) Aguante

Lie down Acuéstese

Look Mire

Maintain Mantenga

Move Muévase

Open Abra

Put Ponga

Relax Relajase

Repeat Repitase

Sign (signature) Firme

Sit down Siéntese

Stop Pare

Stretch Estírase

Try Intente

Stand up Levantase

Walk Ande/Camine

39

Directions/Positions:

Backwards Hacia atras

Behind Detras de

Below Debajo de

Down Abajo

Face down Boca abajo

Face up Boca arriba

Forward Adelante

Front Frente

Here Aqui

Inside Adentro

On top of Encima de

On your left side Sobre el lado izquierda

On your right side Sobre el lado derecho

Outside Afuera

There Alli

To the left A la izquierda

To the right A la derecha

Toward Hacia

Up Arriba

40

Anatomy:

Abdomen Abdomen

Ankle Tobillo

Arm Brazo

Artificial limb/prosthesis Miembro artificial

Back Espalda

Breast Seno

Buttocks Nalgas

Cheek Mejilla

Chest Pecho

Ear Oreja

Elbow Codo

Eye Ojo

Face Cara

Finger Dedo

Foot Pie

Hand Mano

Head Cabeza

Hip Cadera

Jaw Mandibula

Knee Rodilla

Leg Pierna

Lip Labio

Mouth Boca

41

Anatomy (cont’d.)

Neck Cuello

Nose Nariz

Pelvis Pelvis

Penis Pene

Rectum Recto

Residual Limb Muñón

Rib Costilla

Shin Espinilla

Shoulder Hombro

Side Lado

Spine Espina dorsal

Teeth Dientes

Thigh Muslo

Toe Dedo del pie

Vagina Vagina

Waist Cintura

Wrist Muñeca

42

Appendix B: Chinese (Mandarin) Basic Phrases:

Do you speak English? Nǐ huì shuō yīngyǔ ma?

Good Afternoon Xiàwǔ hǎo

Good Evening/Night Wǎnshàng hǎo

Good Morning Zǎo ān

Have a good day. Zhù nǐ yǒu měihǎo de yītiān

Hello/Hi Nín hǎo

How are you? Nǐ hǎo ma?

How do you say this (point to something) in Chinese?

Rúhé zài zhōngguó zhèyàng shuō?

Please Qǐng

Thank you Xièxiè

What is this? Zhè shì shénme?

What is your name? Nǐ jiào shénme míngzì?

Where is the bathroom? Cèsuǒ zài nǎlǐ?

43

Key Commands: Each command should begin with please / qǐng / chǐng

English Chinese Pronunciation

Bend Wān Whān

Bend Down Chuí Chway

Breathe deeply Chuǎnqì Chu ǎn cheè

Come here Lái zhèlǐ Lie tzèhlee

Close Guānbì Gwan bee

Do Bàn Bhàn

Hold (Resist) Wò zhù Wòh zwoo

Lie down TǎngZhè Taǎng tzèh

Look here KànZhè Khàn tzèh

Maintain Wéichí Way chir

Move Yídòng Yeé dhòng

Open Kāifàng Kai fh àng

Put Fàng Fh àng

Relax Fàngsōng Fh àng tzōng

Repeat Chóngfù Ch óang fo ò

Sign (signature) Qiānmíng Chi ān míng

Sit down Zuò xià Zwò shà

Stop Tíngzhǐ Tíng tzǐ

Stretch Shēnzhǎn Shēn zhǎn

Try Shì kàn kàn Shì càn càn

Stand up Qǐlái Chee lie

Walk Zǒulù Tzo lo ò

44

Directions/Positions:

English Chinese Pronunciation

Backwards Xiànghòu Shiàng hòe

Behind Bèihòu Bày hòe

Below Xiàmiàn Shià myiàn

Down Xiàng xià Shiàng shà

Face down Liǎn cháo Leeyǐan ch ów

Face up Liǎn xiàngshàng Leeyǐan shiàngshàng

Forward Qiánfēng Chián fung

Front Qián Chián

Here Zhèlǐ Zhèl ěe

Inside Lǐmiàn Lěe myiàn

On top of Shàngbian Shàng byiān

On your left side Zài ní de zuǒcè Zài knee du zwǒ tzè

On your right side Zài nǐ yòushǒu biān Zài knee yò swǒ byiān

Outside Wàimiàn Why myiàn

There Nàlǐ Nàh lěe

To the left Kào zuǒ Còw zwǒ

To the right Xiàng yòu Shiàng yò

Toward Wǎng Whǎng

Up Xiàngshàng Shiàngshàng

45

Anatomy

English Chinese Pronunciation

Abdomen Fùbù Foò boò

Ankle Jiǎohuái Jyǎow hwai

Arm Gebo Guh-baw

Back Bèi Bay

Body Shenti Shun-tee

Cheek Liǎnjiá Lyan jiá

Chest Xiōngbù Shyoong-boo

Ear Erduo Are-dwaw

Elbow Wān tóu Whān tóe

Eye Yanjing Yan-jeeng

Face Liǎn Liǎn

Finger Shouzhi Show-Jir

Foot Jiao Jyaouw

Hand Shǒu Show

Head Tóu Toe

Hip Túnbù Twun boo

Knee Xīgài She guy

Leg Tuǐ Tway

46

Anatomy (cont’d.)

Neck Bózi Bwózi

Shoulder Jiān bǎng Jyang bǎhng

Side Cèmiàn Tzè-myàn

Spine Jǐzhù Gee-zhoo

Teeth Yáchǐ Ya-tzi

Thigh Dàtuǐ Dà-tway

Toe Jiǎozhǐ Jyaouw-zhi

Waist Yāo Yāo

Wrist Wàn Whan

47

Appendix C: French Creole Basic Phrases:

Do you speak English? Eske ou pale angle?

Good Afternoon Bôn aprèmidi

Good Evening/Night Bonswa

Good Morning Bonjou

Goodbye Orevwa

Have a good day. Pase yon bònn jounen

Hello/Hi Alo

How are you? Kôman ou ye?

How do you say this (point to something) in Creole?

Ki jan ou sa a nan kreyòl?

Please Sil vou plè

Thank you Mèsi

What is this? Ki sa ki sa a?

What is your name? Kôman ou rele?

Where is the bathroom? Kote twalèt la?

48

Key Commands/Phrases: Each command should be followed with please/souple

Bend Pliye

Breathe deeply Respire pi byen

Come here Vini non isit la

Close Close

Do Èske

Hold (Resist) Kenbe

Lie down Kouche

Look at Gade

Maintain Kenbe

Move Deplase

Open Louvri

Put on Mete

Relax Rilaks

Repeat Repete

Sign (signature) Siyen

Sit down Chita

Stop Sispann

Stretch Detire kò

Try Eseye

Stand up Kanpe

Walk Mache

49

Directions/Positions:

Backwards Bak

Behind Dèyè

Below Pi ba a

Down Atè

Here Isit la

Inside Anndan

On top of Sou tèt

On your left side Sou bò gòch ou

On your right side Sou bò dwat ou

Outside Deyò

There Gen

To the left Sou bò goch la

To the right Sou bò dwat la

Toward Nan direksyon

Up anlè

50

Anatomy:

Abdomen Vant

Ankle Chevi

Arm Bra

Artificial limb/prosthesis Pwotèz

Back Do

Breast Tete

Buttocks Men

Cheek Bò figi

Chest Lestomak

Ear Zòrèy

Elbow Koud bra

Eye Je

Face Figi

Finger Dwèt

Foot Pye

Hand Men

Head Tèt

Hip Anch

Jaw Machwè

Knee Jenou

Leg Janm

Lips Po bouch

Mouth Djòl

51

Anatomy (cont’d.)

Neck Kou

Nose Nen

Pelvis Basen

Penis Kòk

Rectum Rektòm

Residual Limb Rezidyèl Mamb

Rib Zo kòt

Shin tibya

Shoulder Zepòl

Side Side

Spine Kolòn vètebral

Teeth Dan

Thigh Kuis

Toe Zòtèy

Vagina Vajen

Waist Anch

Wrist Jwenti Men

52

Appendix D: Portuguese : Basic Phrases:

Good Afternoon Boa tarde

Good Evening/Night Boa noite

Good Morning Bom dia

Have a good day Tenha um bom dia

Hello Ol á

How are you? Como você está? / Como vai?

How do you say [this]? Como se diz? / Como se fala?

Please Por favor

Thank you Obrigado (male) / Obrigada (female)

You are welcome De nada

What is this? O qu ê é isso?

What is your name? Como se chama você? / Qual é o seu nome?

Where is the bathroom? Onde fica / está o banheiro?

Who? Quem?

Why? Por quê?

53

Key Commands: Each command should be followed with “please / por favor”.

Bend Curve

Bend down Curve-se

Bend over Incline-se

Breathe deeply Respire profundamente

Come here Venha aqui

Close Feche

Do Faz / Faça

Hold (Grasp) Agarre

Hold (Resist) Resista

Lie down Deite / Recline

Look Olhe

Maintain Manta

Move Mova

Open Abra

Pull Puxe

Push Empurre

Put Ponha

Relax Relaxe

Repeat Repita

Sign (signature) Assine

Sit down Sente-se

Stop Pare

Stretch Estique-se / Espiche-se

Touch Toque

54

Key Commands Cont’d):

Try Tente

Stand up Levante-se

Walk Ande-se / Caminhe-se

55

Directions/Positions:

Backwards Para trás

Behind Atrás

Below Abaixo (de)

Down Baixo

Face down Virado para baixo

Face up Virado para cima

Forward Para a frente

Front Frente

Here Aqui

Inside Dentro (de)

On top of Em cima de

On your left side No lado esquerdo

On your right side No lado direito

Outside Para fora

There Lá

To the left Para a esquerda

To the right Para a direita

Toward Para / em direção a

Up Acima / para cima

56

Anatomy:

Abdomen Abdômen

Ankle Tornozelo

Arm Braço

Artificial limb/prosthesis Prótese / membro artificial

Back Costas

Breast Seio / peito

Buttocks Nádegas

Cheek Bochechas

Chest Peito

Ear Orelha / ouvido

Elbow Cotovelo

Eye Olho

Face Cara

Finger Dedo

Foot Pé

Hand Mão

Head Cabeça

Hip Quadril

Jaw Mandíbula

Knee Joelho

Leg Perna

Lip Lábio

Mouth Boca

Neck Pescoço

57

Nose Nariz

Pelvis Pélvis

Penis Pênis

Rectum Reto

Residual limb Resto de / membro residual

Rib Costela

Shin Canela

Shoulder Ombro

Side Lado

Spine Espinha

Teeth Dentes

Thigh Coxa

Toe Dedo (do pé)

Vagina Vagina

Waist Cintura

Wrist Pulso

58

Appendix E: Swahili Basic Phrases:

Hello/hi Jambo

Hello (respectful greeting to an elder) Shikamo

Response to respectful greeting Marahaba

Goodbye Kwaheri

How are you? Habari gani?

I’m good Nzuri

Good morning Habari za asubuhi

Good afternoon Habari za mchana

Good evening/night Habari za jioni

Have a good day Habari za leo

Thank you Asante

You’re welcome Karibu

Please Tafadhali

Sorry Pole

Excuse me Samahani

How do you say this (point to something)

in Swahili?

Unasemaje?

What is this? Ni gani?

What is your name? Jina lako nani?

My name is… Jina langu ni…

Where is the bathroom? Vyoo viko wapi?

Do you speak English? Unasema Kiingereza?

Yes Ndiyo

No Hapana

59

Key commands/phrases:

Bend Pinda

Bend down Inama

Bend over Forama

Breathe Vuta pumzi

Close Funga

Come Ja

Do Fanya

Hold (resist) Pinga

Jump Ruka

Lie down Lala chali

Look Tazama

Move Hama

Open Fungua

Pull Vuta

Push Sukuma

Put Weka

Relax Legeza

Repeat Rudia

Run Kimbia

Sign (signature) Weka saini

Sit down Kaa

Stand up Wa wima

Stop Simama

Stretch Nyosha

Touch Gusa

Try Fanya bidii

60

Turn Geuza

Walk Tembea

61

Directions/Positions:

Backwards Kinyumenyume

Behind Nyuma

Below Chini

Down Chini

Face down Uso chini

Face up Uso juu

Forward Mbele

Front Mbele

Here Hapa

Inside Ndani

On top of Juu ya

Outside Nje

There Huko

Left Kushoto

Right Kulia

Toward Kuelekea

Up Juu

62

Anatomy:

Abdomen Fumbatio

Ankle Kiwiko cha mguu

Arm Mkono

Artificial limb/prosthesis Viungo bandia

Back Mgongo

Breast Ziwa

Buttocks Matako

Cheek Shavu

Chest Kifua

Ear Sikio

Elbow Kiwiko

Eye/s Jicho (singular), Macho (plural)

Face Uso

Finger Kidole

Foot Mguu

Hand Mkono

Head Kichwa

Hip Nyonga

Jaw Taya

Knee Goti

Leg Mguu

Lip Mdomo

Mouth Mdomo

Neck Shingo

Nose Pua

Pelvis Fupanyonga

Penis Uume

63

Anatomy (Cont’d)

Rectum Rektamu

Residual limb Kiungo a mabaki

Rib Ubavu

Shin Muundi

Shoulder Bega

Side Upande

Spine Uti

Stomach Tumbo

Thigh Paja

Toe Kidole cha mguu

Vagina Kuma

Waist Kiuno

Wrist Kiwiko

64

Appendix F: French Basic Phrases:

Yes Oui

No Non

Hello Salut

Good morning Bonjour

Good afternoon Bonne après-midi

Good evening Bonsoir

Good night Bonne nuit

Have a good day Bonne journée

How are you? (formal) Comment allez-vous?

How are you? (informal) Comment vas-tu?/ Ca va?

How do you say this (point to something) in French?

Comment-on dit (point to something) en français?

Please S'il vous plaît

Thank you Merci

What is this? Qu'est-ce que c'est?

What is your name? (formal) Comment vous appelez-vous?

What is your name? (informal) Comment t’appeles tu?

Where is the bathroom? Où se trouvent les toilettes? /Où est la salle de bains?

You’re welcome De rien

65

Simple Commands (in formal/plural conjugation):

Bend Pliez

Bend down Penchez-vous

Breath deeply Respirez profondément

Come here Venez ici

Close Fermez

Do Faites

Lie down Allongez-vous/ Couchez-vous/ Reposez-vous

Look Regardez

Maintain Maintenez

Move Déplacez-vous

Open Ouvrez

Put Mettez

Relax Détendez

Repeat Répétez

Sign (signature) Signez

Sit down Asseyez-vous

Stop Arrêtez

Stretch Étirez

Try Essayez

Stand up Levez-vous

Walk Marchez

66

Directions/Positions:

Backwards En arrière

Behind Derrière

Below En dessous/ en bas

Down Vers le bas/ en bas

Forward En avant

Front Avant/ en face

Here Ici

Inside À l'intérieur/ dedans

On top En haut

On your left side Sur votre gauche

On your right side Sur votre droite

Outside À l'extérieur/ dehors

There Là

To the left À gauche

To the right À droite

Toward Vers/ du côté de

Up En haut

67

Anatomy:

Abdomen L’abdomen

Ankle La cheville

Arm/ arms Le bras/ les bras

Artificial limb/prosthesis Le membre artificiel/ le prothèse

Back Le dos

Breast Le sein

Buttocks Les fesses

Cheek La joue

Chest La poitrine/ la cage thoracique

Ear La oreille

Elbow Le coude

Eye/ eyes L’œil/ les yeux

Face Le visage

Finger Le doigt

Foot Le pied

Hand La main

Head La tête

Hip La hanche

Jaw La mâchoire

Knee/ Knees Le genou/ les genoux

Leg La jambe

Lip La lèvre

Mouth La bouche

Neck Le cou

68

Anatomy (cont’d):

Nose Le nez

Pelvis Le bassin/ le pelvis

Penis Le pénis

Rectum Le rectum

Residual Limb Le membre résiduel

Rib La nervure

Shin Le tibia

Shoulder/ shoulders L’épaule/ les épaules

Side La côté

Spine La colonne vertébrale

Teeth Les dents

Thigh La cuisse

Toe Le doigt de pied/ l’orteil

Vagina Le vagin

Waist La taille

Wrist Le poignet

69

X. Meet the Contributors/Editors THE CONTRIBUTORS:

Ashley Alagna, SPT Carroll University Global Health Project Committee Member 2015 Global Outreach Project Committee Member 2016 Alagna is a third year student at Carroll University in Waukesha, WI. She has had the opportunity to attend several state conferences and hopes to be able to attend APTA national conferences in the future. She also serves as a member of the Wisconsin Student Special Interest Group executive board. She has not yet had the opportunity to participate in an international service learning trip, she has traveled to Ireland, London, and Paris through a study abroad program at her school. Alagna serves on the Global Health Project

Committee to help facilitate opportunities for students and practitioners to better serve the global population.

Rachel Buckner PT, DPT University of Southern California Global Health Project Committee Member 2015 Global Outreach Project Committee Member 2016

Rachel is a recent graduate of the DPT program at the University of Southern California,. She became very involved in community service during her undergraduate education at the University of Virginia, traveling both domestically to New Orleans and internationally to Jamaica. She hopes to continue giving back to her community and to the world during her career, utilizing this experience for international medical service trips in the near future. Buckner’s goal is that her involvement on this committee can improve the ease with which she and other physical therapists/physical therapy students can find the assistance and guidance needed to travel for community service.

70

Tessa Comstock, SPT The College of St. Scholastica Global Outreach Project Committee Member 2016 Tessa is a second year student in the DPT program at The College of St. Scholastica in Duluth, Minnesota. She studied abroad in Tanzania and had an internship working with people who had or were at risk for having HIV/AIDS. After college graduation she spent a year in East Malaysia working at a school for children and young adults with physical and intellectual disabilities. Although she has not participated

on a physical therapy focused international service experience yet, she aspires to in 2017. Comstock’s goal for being a member of the committee is to assist physical therapists and physical therapy students in being able to serve globally and participate in international service opportunities.

Randy Kaw, SPTA

Oakton Community College Global Outreach Project Committee Member 2016 Building on the outstanding work of previous students, Randy is honored to serve alongside the passionate members of this committee. He hopes to enhance our abilities to understand and address systemic health disparities at home and abroad. An active member of the Illinois PTA and APTA, Randy is a proud graduate of the Physical Therapist Assistant program at Oakton Community College in Des Plaines, Illinois.

Monica Lee, SPT Maryville University of Saint Louis Global Outreach Project Committee Member 2016 Monica Lee is a second-year student at Maryville University of Saint Louis. She has participated in PT international service learning trips to Vietnam, Cambodia, and Nepal, and has also traveled to Italy and Hong Kong on non-PT study abroad trips. During her six weeks spent in Kathmandu, Nepal, she volunteered in the Spinal Injury Rehabilitation Centre for Nepal and provided PT services to patients who had sustained spinal injuries from the devastating earthquakes of April and

71

May 2015. Monica is passionate about building and creating sustainable relationships on a global level to provide students, clinicians, and communities the best possible care. She hopes this committee will provide members of the healthcare team across all disciplines a great resource for getting involved in international service.

Brittney Townsend, SPT

Southwest Baptist University Global Health Project Committee Member 2015

Brittney Townsend is a third year student at Southwest Baptist University. In 2014, she had the opportunity to go to Peru with SBU on a medical mission trip that was solely physical therapy-related. Peru is the first service learning opportunity she has had with hopes of going on more trips. Townsend is excited to serve on this committee because of her love for and serving others on an international level come together. With the realization that not everyone is afforded the same access to

health education, Townsend intends to help students and clinicians build long-lasting relationships through international service learning (ISL) trips. Townsend’s goal is to expand her experience with ISL and incorporate ISL into her practice as a Physical Therapist.

Michael Weinand, SPT Northern Arizona University Global Health Project Committee Member 2015 Michael Weinand is a 3rd year DPT student at Northern Arizona University. Weinand serves on this committee because he is interested in physical therapy and global health. In 2011 he taught English to monks and orphans at a refugee camp in Thailand. While he was in Thailand he observed at a clinic that provided prosthetics to people who suffered amputations due to landmines from the Burmese Civil War. His goal is to work for an organization, such as Handicap International, that provides similar services. This year,

Weinand attended a rehabilitation conference in Hong Kong where he met clinicians and students from over 15 different countries. In Hong Kong he had the opportunity to learn about Traditional Chinese Medicine (TCM) and how TCM can be integrated with western rehabilitation techniques. He believes that by serving on this committee he can make it easier for other students to have ISL experiences.

72

Samantha Weng, SPT California State University, Long Beach Global Health Project Committee Member 2015 Weng is a third year DPT student at California State University, Long Beach. She loves traveling internationally and has spent time in Canada, Europe, Israel, Japan, Jordan, and Taiwan. She has been on non-PT service trips to China and Mexico. Although she has not been able to participate in a Physical Therapy-focused international service learning experience, she aspires to go in the near future. Weng was a member of the Minority and International Affairs Committee last year. Weng’s goal is to keep the momentum and flow going by creating a

great resource for those who wish to serve internationally.

THE EDITORS: Christina Machaby Lee, SPT (Lead Author and Editor) Boston University Global Health Project Committee Member 2015 Global Outreach Project Committee Chair 2016 Global Health Special Interest Group Student Liaison Christina Lee is a third year student in the DPT program at Boston University. Christina’s passion for global health was sparked during her 2 year service as a Peace Corps volunteer in Burkina Faso from 2012-2014. She served in the Education and Health sectors and served as President of the Community Health and AIDS Taskforce,

during which time she oversaw country-wide efforts focused on Malaria and HIV/AIDs prevention. Christina was a member the GHPC in 2015 and is thrilled to be serving as the Chair of the GOPC in 2016. She is also a student liaison to HPA the Catalyst’s Global Health Special Interest Group for the APTA. Currently she is focusing her culminating DPT practicum project on collaborating with local healthcare providers to implement a rehabilitative exercise program for women in the Democratic Republic of Congo who are survivors of wartime violence. Christina’s passion in global health revolves around helping students and professionals to promote culturally appropriate, sustainable and community-based solutions to health problems around the world.

73

April Fajardo, PT, DPT (Lead Author and Editor) Southwest Baptist University Global Health Project Committee Co-Chair 2015 Fajardo is a recent graduate of Southwest Baptist University (SBU) in Bolivar, Missouri. She was a member of the Minority and International Affairs Project Committee in 2014. Fajardo now served as the Global Health Project Committee Co-Chair with Josh Greensweig in 2015. She served on four international service learning (ISL) trips: Brazil, Peru, and two in Haiti. Of the four medical mission trips, two have been interdisciplinary and two have been solely physical therapy teams. Fajardo’s passion

for International Service Learning has directed her career path to pursue traveling physical therapy to enable the flexibility to serve on international medical mission trips. Her dedication to service has been nationally recognized by the American Physical Therapy Association at the NEXT Conference in National Harbour, MD in June 2015. Fajardo was one of eight recipients of the APTA Minority Scholarship Award in 2015.

Josh Greensweig, SPT University of Minnesota Global Health Project Committee Co- Chair 2015 Greensweig is a 2nd year DPT student at the University of Minnesota. His passion lies in understanding environmental factors that contribute to health disparities across the world. He hopes to use geographical data to help eliminate disparities in physical therapy treatment and outcomes related to noncommunicable disease, both in the United States and abroad. Greensweig is an active member of the APTA, serving on the Minnesota chapter’s state government affairs and membership committees, in addition to his role as co-chair of the Student Assembly

Global Health Project Committee.

74

Kelsie Miller, SPT (Author and Editor) Mayo School of Health Sciences Global Health Project Committee Member 2015 Global Outreach Project Committee Member 2016 Global Health Special Interest Group Student Liaison Kelsie Miller is a 3rd year DPT student at Mayo School of Health Sciences in Rochester, Minnesota. She was a Fulbright English Teaching Assistant in Gorontalo, Indonesia during the 2013-2014 academic year and studied abroad at the University of Otago in Dunedin, New Zealand in 2011. She was a local ambassador for Global PT Day of Service in 2015 and currently serves as the Mayo DPT Class of 2017 Class President and as a student liaison to HPA the Catalyst’s Global Health Special Interest Group for the APTA.

Miller participated in an ISL experience in Honduras in March 2016 on a team with American PT students, physiatrists, physical therapists, and Honduran functional therapy students and residents. Her goal is to provide similar international opportunities for students in the future and to explore rehabilitation concepts and beliefs in other cultures.

Jillian Carney, PTA, BS St. Catherine University Student Assembly Board of Directors, Nominating Committee Member Global Health Project Committee SABOD Liaison Jillian is a born-and-raised Minnesotan living in Pensacola, FL as a new professional at an Outpatient Orthopedic clinic. She has the immense pleasure of serving on the Student Assembly Board of Directors as the

Nominating Committee Member. During her PTA schooling, she was the Co-Chair of the MNPTA SSIG, Class Representative and recipient of the Mary McMillan Scholarship. Jillian traveled to the Dominican Republic with 20 SPTs and SPTAs for her final clinical rotation on an ISL Program and fell in love with the passion, humility and values of the country. Currently, she serves as the PTA Director for the Early Professionals SIG and is a member of the Membership Committee for the Florida Physical Therapy Association.

75

Ryan Maddrey, SPT Medical University of South Carolina Student Assembly Board of Directors, Nominating Committee Chair-Elect Global Outreach Project Committee SABOD Liaison Ryan is a lifelong resident of South Carolina attending Clemson University for his undergraduate degree and moving to Charleston, SC to focus on attaining his DPT at MUSC. He has had the pleasure

to serve his fellow students as the Nominating Committee Chair-Elect on the APTA Student Assembly Board of Directors. With this organization, he has been able to be the liaison to the Global Outreach Project Committee. His interest in global outreach stems from the medical mission trip he took to Masindi, Uganda with a comprehensive healthcare team to provide a wide range of medical treatment through One World Health.

XI. Special Thanks: Josh D’Angelo, PT, DPT Doctor of Physical Therapy 2013 APTA Student Assembly President and Co-Founder of PT Day of Service Fred Gilbert, PT, DPT Doctor of Physical Therapy 2015 APTA Student Assembly President Jeanine Gunn, PT, DPT Board of Director Liaison American Physical Therapy Association Efosa Guobadia, PT, DPT Doctor of Physical Therapy Founder of PT Haven and Co-Founder of PT Day of Service Lisa McLaughlin Staff Liaison American Physical Therapy Association Beverly McNeal, PT, DPT, GCS Associate Professor and Global Health Coordinator Southwest Baptist University

76

Global Health Special Interest Group Leadership HPA The Catalyst Section American Physical Therapy Association

77

XII. REFERENCES:

1. Koplan J, Bond T, Merson M et al. Towards a common definition of global health. The Lancet. 2009;373(9679):1993-1995. doi:10.1016/s0140-6736(09)60332-9.

2. Rowson M, Willott C, Hughes R et al. Conceptualising global health: theoretical issues and their relevance for teaching. Globalization and Health. 2012;8(1):36. doi:10.1186/1744-8603-8-36.

3. Pechak CM, Thompson M. Going global in physical therapist education: International service-learning in US-based programmes. Physiotherapy Research International. 2011;16(4):225-236. doi:10.1002/pri.501.

4. Seifer SD. Service-learning: community–campus partnerships for health professions education. Academic Medicine 1998; 73 (3): 273–277. DOI: 10.1097/00001888-199803000-00015

5. Martiniuk ALC, Manouchehrian M, Negin JA, Zwi AB. Brain Gains: a literature review of medical missions to low and middle-income countries. BMC Health Serv Res. 2012;12:134. doi: 10.1186/1472-6963-12-134.

6. Pechak CM, Thompson M. International service-learning and other international volunteer service in physical therapist education programs in the United States and Canada: an exploratory study. J Phys Ther Educ. 2009; 23(1):71–79.

7. Hoppes S, Bender D, DeGrace BW. Service Learning is a Perfect Fit for Occupational and Physical Therapy Education. Journal of Allied Health. 2005;34(1):47-50

8. Lattanzi JB, Pechak C. A Conceptual Framework for International Service-Learning Course Planning: Promoting a Foundation for Ethical Practice in the Physical Therapy and Occupational Therapy Professions. Journal of Allied Health . 2011;40(2):103-109.

9. Nickols S, Rothenberg N, Moshi L, Tetloff M. International Service-Learning: Students’ Personal Challenges and Intercultural Competence. Journal of Higher Education Outreach and Engagement. 2013;17(4):97-124. Doi:1534-6104.

10. Abedini N, Gruppen L, Kolars J, Kumagai A. Understanding the Effects of Short-Term International Service–Learning Trips on Medical Students. Academic Medicine. 2012;87(6):820-828. doi:10.1097/acm.0b013e31825396d8.

11. Crump, J.A., & Sugarman, J. (2008). Ethical considerations for short-term experiences by trainees in global health. Journal of the American Medical Association, 300 (12): 1456-1458. doi:10.1001/jama.300.12.1456.

78

12. Atuyambe, L.M., Baingana, R.K., Kibira, S.P., Katahoire, A., Okello, E., Mafigir, D.K., Ayebare, F., Oboke, H., Acio, C., Muggaga, K., Mbalinda, S., Nabaggala, R., Ruzaaza, G., Arubaku, W., Mary, S. Akera, P., Tumwine, J.K., Peters, D.H., & Sewankambo, N.K. (2016). Undergraduate students’ contributions to health service delivery through community-based education: a qualitative study by the MESAU consortium in Uganda. BMC Medical Education, 16 (123). doi: 10.1186/s12909-016-0626-0

13. Ross, M.E. (2012). Linking classroom learning to the community through service learning. Journal of Community Health Nursing, 29: 53-60. doi: 10.1080/07370016.2012.645746

14. Crump, J.A., Sugarman, J. and the Working Group on Ethics Guidelines for Global Health Training (WEIGHT). (2010). The American Journal of Tropical Medicine and Hygiene , 83(6), 1178-1182.

15. Pinto, A.D. & Upshur R.E.G. (2009). Global health ethics for students. Developing World Bioethics, 9 (1), 1-10.

16. Marmot M, Friel S, Bell R, Houweling T, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. The Lancet. 2008;372(9650):1661-1669. doi:10.1016/s0140-6736(08)61690-6.

17. Yang A, Farmer P, McGahan A. ‘Sustainability’ in global health. Global Public Health. 2010;5(2):129-135. doi:10.1080/17441690903418977.

18. McVeigh et al. Promoting good policy for leadership and governance of health related rehabilitation: a realist synthesis. Globalization and Health. 2016; 12:49. DOI: 10.1182/s12992-016-0182-8.

19. Ozawa S, Singh S, Singh K, Chhabra V, and Bennett, S. The Avahan Transition: Effects of Transition Readiness on Program Institutionalization and Sustained Outcomes. PLoS ONE. 2016; 11:7. DOI: 10.1371/journal.pone.0158659.

20. Tindana P, Singh J, Tracy C et al. Grand Challenges in Global Health: Community Engagement in Research in Developing Countries. PLoS Med. 2007;4(9):e273. doi:10.1371/journal.pmed.0040273.

21. Shields M, Quilty J, Dharamsi S, Drynan D. International fieldwork placements in low-income countries: Exploring community perspectives. Australian Occupational Therapy Journal. 2016. doi:10.1111/1440-1630.12291.

79

22. Li Y, Cao J, Lin H, Li D, Wang Y, He J. Community health needs assessment with precede-proceed model: a mixed methods study. BMC Health Services Research. 2009;9(1):181. doi:10.1186/1472-6963-9-181.

23. Stevens A, Gillam S. Health needs assessment: Needs assessment: from theory to practice. BMJ. 1998;316(7142):1448-1452. doi:10.1136/bmj.316.7142.1448.

24. Wright J, Walley J. Health needs assessment: Assessing health needs in developing countries. BMJ. 1998;316(7147):1819-1823. doi:10.1136/bmj.316.7147.1819.

25. MacQueen K, Bhan A, Frohlich J, Holzer J, Sugarman J. Evaluating community engagement in global health research: the need for metrics. BMC Medical Ethics. 2015;16(1). doi:10.1186/s12910-015-0033-9.

26. Miller B, Eichbaum Q, Brady D, Moore D. Aligning Health Sciences Education with Health Needs in Developing Countries. Academic Medicine. 2011;86(11):e10. doi:10.1097/acm.0b013e318232cc8