Jennifer Everhart, PT, MPT, With Patients at Hope House, The

8/14/2019 Jennifer Everhart, PT, MPT, With Patients at Hope House, The

1/1122 S e p t e m b e r 2 0 0 9

Jennifer Everhart, PT, MPT, with patients at Hope House,

the nongovernment organization in Niamey, Niger,

for which she works. The children pictured are being

treated there for clubfoot, post-op bone deformities,

and plantarflexion contractures.


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PTm a g a z i n e 23

As a physical therapist (PT) inUkraine, Sandra Kunanec, BScPT,

navigates a health care system shebluntly describes as in crisis. The humanneed is great, infrastructure is lacking,salaries are poor, and services for people

with disabilities barely existthe legacy ofa Soviet era in which, Kunanec disdainfully

observes, Everybody was healthy.Officially, that is. In reality, people with disabilities were tucked into a cor-ner at home, or sent to an institution,she says. The strong survived, and thatwas it. In 2009, were still dealing withthe old Soviet system, Kunanec notes.Legislation and care guidelines are archaic,insufficient, and dont come close to meet-ing the needs of this population.

As one of only 120 members of theUkrainian Association of Specialists of

Physical Rehabilitation (as UkrainianPTs are known) in a nation of 45 mil-lion, Kunanec concedes to often feelingoverwhelmed. Had she not married aUkrainian citizen, she might feel temptedto return to a comfortable life in her nativeCanadaexcept for one thing.

What keeps me going is why I endedup staying in the first place, she says.Kunanec, born of Ukrainian-Canadianparents, was visiting family in Ukraine in

19932 years after independence fromthe old Soviet Unionwhen she touredone of countrys newly legalized non-gov-ernment organizations. This one had beenformed by parents of children with cere-bral palsy who had declined to follow theSoviet-era practice of giving up their sonsand daughters to the state-run system ofinternats, or orphanageswhere such chil-dren essentially were and are warehoused.

I was very moved, Kunanec says.These parents wanted something bet-

ter for their kids and were determined to

secure that for them.Inspired to jointhat fight, she co-founded the DzereloRehabilitation Centrein the city of Lviv.We now see quite

remarkable results achieved with childrenwhose situations we once thought hope-less, she says.

The Ukrainian Association of Specialistsof Physical Rehabilitation is applying for

membership in the World Confederationfor Physical Therapy (WCPT), with a voteexpected at the general meeting immedi-ately preceding the organizations next con-ference, to be held in Amsterdam in 2011.Membership in the WCPTwhich rep-resents more than 300,000 PTs (physicaltherapists and physiotherapists, as PTs areknown in many nations) in 101 countriesspanning all six inhabited continents will improve the professions prestige in

Ukraine, help us forge a stronger iden-tity, and increase our skills and knowledgethrough professional development andnetworking opportunities, Kunanec feels.

Those goals dovetail with the purposeof the 58-year-old WCPT, which describesitself on its Web site (www.wcpt.org) ascommitted to furthering the physicaltherapy profession and improving globalhealth by encouraging high standards ofphysical therapy research, education andpractice; supporting the exchange of infor-

In Brief

There are many reasons to take interest

in the contributions and activities of your

PT colleagues around the globe, whether

or not you choose to work alongside

them. Among the most compelling are:

v Learning from their research

findings.

v Learning from their clinical

approaches to different care

models and practice patterns.

v Taking advantage of advanced

training opportunities overseas.

v Personal growth, whether in working

with diverse populations or in gain-

ing new perspectives on what you

do and why you do it that way.

v Gaining insights from other PTs

successes in battling sometimes-

daunting challenges.

v Identifying ways in which you can

help PTs and patients overseas,

particularly in developing nations.

v Deepening your understanding

of the ways in which all PTs can

advance physical therapy as a

doctoring profession.

Kumanec

by Eric Ries

Physical therapists across the globe face many of the same problems andare responding with common strengths.

Makinga

Worldof

Difference


3/11

24 S e p t e m b e r 2 0 0 9

CCISIG: Developing Resources for theDeveloping World

Celia Pechak, PT, PhD, MPH, calls the APTA Section on Healthy

Policy & Administrations Cross Cultural and International Special

Interest Group (CCISIG) the associations best-kept secret. But

clearly word has been getting out the past few years, given that

membership has jumped from around 50 as recently as 2005 to 220as of this June.

It isnt intuitive for PTs interested in global health issues to look

for that under Health Policy & Administration, notes Pechak, the

CCISIGs vice chair. She adds that about 4 years ago the 23-year-

old group committed to embracing new communication tools and

developing additional resources to better address the broad interests

of its existing and potential members. One of those resources is an

electronic mailing list that offers CCISIG members a convenient and

practical way to network, collaborate, and share information.

Were all in our little pockets of expertise and geography, trying

to do the right thing, Pechak notes, but the more we can connect,

the greater our impact can be. Shes got personal experience in mak-

ing global connections, having initiated Health Volunteers Overseas

physical therapy training program in Haiti and having conducted

training for that nonprofit group in Vietnam, as well. But Pechak, an

mation between WCPT regions and mem-ber organizations; and collaborating withnational and international organizations.

The WCPT offers an array of guidelinesand services, including policy statements,educational support, practice resources,and electronic discussion forums on a vari-

ety of subjects. Its quadrennial congresses,which draw thousands of PTs, are scientificevents that showcase advancements world-

wide in physical therapy research, practice,and education.

Ukraines experience with physicaltherapy as a developing country in some

ways parallels the professions historyin other nations represented within the WCPT. But WCPT President Marilyn

Moffat, PT, DPT, PhD, CSCS, FAPTA,emphasizes that wherever PTs are foundin developing countries where the pro-fession is struggling to establish itself;as well as in developed nations wherephysical therapy has a longer track record,PT education levels may be higher, careprovision may be less problematic, andproduction of evidence-based researchmay be more robustthe challenges PTsface are similar. And, Moffat adds, the

strengths that PTs possessepitomized byKunanecs resolve to overcome obstacles inUkraineare universal.

We all struggle with such issues asphysician attempts to control practice, get-ting government and regulatory agenciesto listen to our patient-centered concernsand understand that we provide the bestservices to the populations we serve, lackof resourcesparticularly in underservedareas, securing appropriate remunerationfor our services, and striking a balance

between our personal and professionalWCPT President Marilyn Moffat, PT, DPT, PhD, CSCS, FAPTA, with colleagues and officials in Dubai.

Celia Pechak, PT, PhD, MPH, training rehabilitation technicians in Haiti.(Photo courtesy of Health Volunteers Overseas)


4/11

lives, Moffat observes. But, she adds,the burden is particularly acute for mycolleagues practicing in the poorest areas

of the world, who struggle to provide ade-quate services to so many, to perhaps get just one PT education program started,and to eke out a living with extremely lowpay scales.

Scanning the global horizon, Moffat,a former president of APTA, sees reasonsfor great pride and great hope. Physicaltherapists in many countries have pio-neered aspects of practice, she notes.Educational requirements are increasing

around the globe, and electronic com-munication is drastically changing theability of PTs to learn and advance theirskills instantaneously.

Aptitude Plus Attitude As WCPT Executive Committee

member for the Africa region, SylviaKambalametore, RPT, MSc, NDT,Cert OMT, chair of the 22-memberPhysiotherapy Association of Malawi, is

doing her utmost to help bring the glob-

al store of physicaltherapy knowledgeto her developing

nation.She received

her undergraduatedegree in the formerWest Germany, andher masters degree

in the United Kingdom, because Malawidoes not have a school of physical ther-apy. Thus, the nation of 14 millionscontingent of fewer than 30 PTs aregraduates either of degree programs in

Europe or 3-year diploma programs inneighboring countries such as Zambiaand Tanzania.

Rather than dwell on the innumerablechallenges of being a private practitionerin the Malawian capital of Lilongwe, how-ever, Kambalametore prefers to focus onthe positives. Its been a slow process, buta school of physiotherapy is coming, shesays confidently. No, the government andhealth insurance do not pay much for PTservices, but Kambalametore makes do

by asking patients to supplement those

payments by contributing as best theycan. The shortage of health care facilitiesmeans patients are likely to receive acute,

sub-acute, and rehabilitative care at thesame location and be seen by the samePT through the entire recovery process.This means the limited number of PTs,occupational therapists, and other healthcare professionals in Malawi must worktogether extremely closely. You get verysmart at prioritizing your time, and learnto broaden your skills, Kambalametoreobserves philosophically.

Actually, she says, all of the chal-

lenges make my job ever so interesting.There are no dull moments. There is noroom for burnout.

Kambalametore does concede, however,that her workload is unbelievable. Theresso much to do in the areas of orthopedics,neurology, and infectious diseases. We seebone infection from sometimes wrongly orinadequately treated orthopedic problems.Osteomyelitis. Tuberculosis of the spine,on occasion. The list goes on.

Putting a good face on adversity and

countering difficulty with determination

assistant professor of physical therapy at the University of Texas at El

Paso who also has done volunteer work in Nepal, says she has turned

her international focus to the CCISIG in recent years because I feel at

my core that it benefits the world if physical therapists take a greater

role in global health, and I want to do everything I can to ensure that

APTA members are part of that.

Its fair to say that the CCISIG (click on SIGs at www.aptahpa.org) has succeeded in helping, literally, to put APTA members on the

global map. And Pechak is thrilled with what shes seeing.

Its so exciting to me, she says. Many SIG members are actively

involved in the professions evolution in developing countries

helping physical therapy get established or raise its standards. That

builds sustainable change in those countries. And in countries where

people with disabilities tend to be shut away, Pechak adds, CCISIG

members are serving as advocates for their inclusion in society.

Illustrating the roles CCISIG members are playing in developing

countries overseas are the following three PTs, whose collective body

of experience spans four continents.

Sustainable ServiceDuring her 3 years in the Peace Corps in Cote dIvoire (Ivory

Coast) in the 1990s, Jennifer Everhart, PT, MPT, saw how quickly

and dramatically the lives of people with disabilities could improve

given even minimal exercise, help from assistive devices, and

rehabilitation. Inspired to service, she enrolled in PT school upon

her return to the United States. Since 2007, she has been directorof physical rehabilitation for a non-government organization in

Niamey, Niger, that provides an array of services to people with

disabilities, including school-enrollment assistance, socio-economic

integration via micro-credits and other means, and general commu-

nity development projects. The organizations rehabilitation efforts

run the gamut from community-based care, to coordinating surger-

ies for children, to distributing and fitting prosthetics and orthotics,

to providing special seats or walkers to children with cerebral palsy,

to a weekly casting clinic for children with clubfeet.

Everhart is one of fewer than 50 PTsmost of them graduates

of Nigers 3-year diploma programin a nation of 13 million. She


Kambalametore

MakingaWorldofDifference


5/11

says her biggest professional challenge, unsurprisingly, is not being

overcome by the magnitude of need and instead focusing on where

her time might best be spent. But it is not, she adds, as if her work

lacks deeply satisfying rewards.

The absolute best part of my job, Everhart says, is giving

hope to children who otherwise would have essentially no access to

rehabilitation services, had no idea such services even existed, and

are stigmatized by their society. In addition to cerebral palsy, she

says, there are severe physical impairments related to polio seque-

lae, angular deformities of the lower extremities probably related

to nutritional rickets, burn sequelae, improperly administered injec-

tions, and fracture complications.

Given the underdeveloped health care system, PTs are often

the last health care professionals these individuals encounter,

Everhart observes.

Her advice to other US PTs interested in advancing the profession

in underserved areas of the world? Educate yourself by talking

to others with experience. Find short-term volunteer assignments

through groups such as Health Volunteers Overseas (www.hvousa.

org) to become more familiar with the realities. Be prepared to step

back and recognize your limitations. Be ready for clinical conditions

and practices that will not measure up the standards youve come

to expect. Be patient in identifying how you best can contribute to

improving the conditions you encounter, and mindful of contributing

in a culturally appropriate manner. Find a mentor.

Finally, Everhart adds, it is important we recognize that our

role in international physical therapy increasingly should be transfer

of knowledge. We must identify ways to help local PTs and health

care professionals develop the skills they need to treat disabling

conditions. It is, of course, extremely rewarding to help a child walk

for the first time. But it is critical that we work side by side with local

PTs to pass along knowledge that will ensure sustainable results long

after we have left their country.

clearly are qualities shared by PTs worldwide, whether theyre battling Soviet-eraattitudes in Ukraine, scarce resources in

Africa, reimbursement headaches andencroachment threats in the United States,or, in the Philippines, the strictures ofa 40-year-old law that groups PTs andoccupational therapists, requires physicianapproval for PT services, and limits the roleof PTs to rehabilitation.

Attempts to separate out PTs andrewrite the 1969 law have proven fruitless within the Philippine legislaturewhichhappens to feature a number of physicians,

notes Maria Ruiz-Aguila, MPhysio, PTRP.Frustrating? Immensely, says Ruiz-Aguila, aformer president of the Philippine PhysicalTherapy Association who is a professor atthe University of the Philippines in Manilaand a private practitioner working in pedi-atrics. Yet shes quick to emphasize whatworks about the profession in her country.

In order to receive a bachelor of sci-ence degree in physical therapy and sitfor licensure, students in the Philippinesmust complete a 5-year program, the

final year of which is devoted to intern-

ships, field work, or clinical training. Itsone of the more rigorous programs in thedeveloping world, and a source of pride

to Ruiz-Aguila.High standards must be met in

order to practice physical therapy in thePhilippines, she says. Practice standardshave been raised and education guide-lines have been updated to ensure thatFilipino PTs are in step with the changing

roles of PTs in health care globally.Ruiz-Aguila notes, for example, that

PT education in

the Philippinesincludes a dedicatedcourse and consid-erable fieldwork incommunity-basedrehabilitation. As adeveloping country

Maria Ruiz-Aguila, MPhysio, PTRP (inset) and participants in the Philippines National Physical TherapyDay in 2008.

26 S e p t e m b e r 2 0 0 9


6/11


Stateside SupportLike Everhart, Jeff Hartman, PT, DPT, MPH, credits an eye-

opening overseas experience with setting his career course. Four

months spent in Nepal as assistant coordinator of mobile health

clinics for a volunteer organization exposed me to extreme poverty

and needs and inspired me to do something about it, he says. A

subsequent experience at a rehab clinic in Sierra Leone, where he

was one of four PTs in a nation of 5 million people that had been

devastated by a civil war characterized by torture and amputations,

inspired Hartman to supplement his physical therapy credentials

with a public health degree that would facilitate working in the

international arena.

He now is stateside director of operations for Hillside Health

Care International, which operates a facility in an impoverished

area of southern Belize that includes a freestanding clinic, mobile

clinics operated in coordination with the Belizean Ministry of Health,

and community education programs for local health care workers

and the population at large. I get down to Belize several times a

year, says Hartman, who is based in Wisconsin. My job is to be

the liaison between the clinic staff and the board of directors. I have

my hands in the daily operations of the clinic and in stateside activi-

ties that primarily involve fundraising, recruitment, medication and

supply procurement, and program development.

While emphasizing that he enjoys being a clinician and greatly

appreciates his part-time employer in Madisons understanding of

my passion for international work, he admits that he probably

would do the Hillside work full-time were it financially feasible

and, ironically given his role in serving the underserved in Belize, if

it offered health insurance.

Hartman relishes the role Hillside is playing in Belize and that

physical therapy increasingly is playing in underserved countries.

Doctors and nurses may be able to keep people alive in small

villages around the world, but what kinds of lives do their patients

with disabilities face? he asks. PTs around the world are improv-

in which not everyone can afford to goto hospitals or even clinics, our presenceat the community level is very much

needed, she notes.

Positive TrendsThe quality of physical therapy world-

wide inexorably is linked to how mucheducation PT students receive. On thatscore, Moffat concedes, Theres incred-ible variation globally. But the trend isencouraging.

The WCPTs declaration of principle

for education recognizes that there is con-siderable diversity in the social, econom-ic, and political environments in whichphysical therapy education is conductedthroughout the world but recommendsthat education for entry-level physicaltherapists should be based on university oruniversity-level studies of a minimum forfour years.1

Every WCPT-member country in which PT education is below the bac-calaureate level knows that must change,

Moffat says, and theyre all moving

toward that. In the more-developedcountries, she adds, physical therapyassociations are realizing how important

the DPT program is. Drawing from aPowerPoint presentation shes been shar-ing with audiences around the worldsince assuming the WCPT presidency in June 2007, Moffat offers a quick sum-mary that highlights the breadth of PTeducation programs within each of theWCPTs five regions:vAfrica. Diploma programs are found

in Ethiopia, Kenya, Malawi, Uganda,and Zambia. There are four-year

programs in Ghana, Rwanda, SouthAfrica, Zambia, Zimbabwe, andEgyptwith Egypt now consideringmasters or doctoral-level education.Nigerias situation is interesting, in thatit has four-year degree programs, witha fifth year for internship, available atseven universities. The DPT is beingdiscussed in Nigeria.

vAsia Western Pacific. Diplomaprograms are found in Afghanistan,Cambodia, Fiji, Indonesia, Malaysia,

and Singapore. Fiji and Nepal are mov-

ing toward three-year degree programs.Sri Lanka is moving toward a four-yeardegree program. Four-year degree

programs exist in Australia, Bahrain,Bangladesh, India, Iran, Japan, Kuwait,New Zealand, South Korea, Taiwan,Thailand, and the United Arab

Everhart with a young patient in Niger.


continued on page 30


7/11


8/11

Opposite page, clockwise: A boy with

clubfeet in Niger, Everhart with a smiling

patient, a case of neglected clubfoot on

a 5-year old girl for whom Hope House

provided surgery. Above: Gait training

for a 25-year old amputee. His prosthesis

was made in Hope Houses workshop.


9/11

30 S e p t e m b e r 2 0 0 9

ing quality of life in ways that empower individuals and enhance

communities.

Hartman encourages PTs in the United States to devote what-

ever time and/or money they can to those efforts. Put yourself in

patients shoes, he urges. If you had a child, mother, or brother

who was disabled, who was unable to go to work or school, and

who perhaps even was being abused for being different, wouldnt

you want a better life for that family member?

Overcoming ObstaclesZach Sommermeyer, PT, DPT, has experienced a wide cross-

section of global PT practice, having done a student clinical in

Australia, taught physical therapy for a non-government agency

in Iraq in 2004, and now consulting on Iraqi issues while living in

Ankara, Turkey. Sommermeyer, who grew up in Texas, is network-

ing with aid organizations, universities, and clinicians in Turkey

in pursuit of his long-term goals of providing pro bono services

to underserved populations and developing research and student

partnerships between US entities and Turkish counterparts.

In Australia, he observes, the quality of service delivery

generally is the same as in the United States. In the areas of Iraq

Emirates. Australia and New Zealandare discussing the possibility of institut-ing DPT programs.

vEurope. Theres quite a bit of varia-tion, ranging from diploma programsin Bulgaria, the Czech Republic,Estonia, and Serbia to masters degreeprograms in Belgium and Poland.In between, there are three-yearbaccalaureate programs in Austria,Croatia, the Czech Republic, Demark,Estonia, France, Germany, Italy,Poland, Slovenia, Sweden, and theUnited Kingdom. Four-year bac-

calaureate programs exist in Bulgaria,France, Germany, Greece, Iceland,Ireland, Latvia, Lebanon [grouped inEurope within the WCPT], Malta,the Netherlands, Norway, Portugal,Romania, Spain, Switzerland, and theUnited Kingdom.

v North America Caribbean. It isanticipated that all physical therapyeducation programs in the UnitedStates will be at the DPT entry levelby 2015. Canada is at the masters

entry level. Five WCPT-member

nations in the region have baccalaure-ate programsJamaica, Panama, andSuriname among them. There is a

diploma program in Guatemala.v South America. All countries within

the region that have PT education pro-grams are at the baccalaureate level.One of those South American coun-

tries is Brazil, where Gil Almeida, PT,MS, PhD, Pos-doc, is president of theCouncil of Physical Therapists andOccupational Therapists of the State ofSao Paulo. In that post, he oversees licen-sure and professional standards of about

50,000 PTs and 70,000 occupationaltherapists. Direct access to the servicesof PTs is the law in Brazil. Thats thegood news. The not-so-good news is thatabout a third of the nations 120,000 PTsare unemployed under a system in whichgovernment reimbursement for PT ser-vices is minimal.

Still, Almeida is optimistic thatgovernment funding will increase asBrazilian politicians increasingly recog-nize that physical therapy helps decrease

health care costs and improves qual-

ity of life. Thepoliticians featurebeautiful hospitals

and clinics in theircampaigns, seekingto sway voters, heobserves. Qualityhealth care makes

voters happy, and politicians ultimately will make that connection to physicaltherapy.

(Of two large countries that are not WCPT members, Brenda Myers, theorganizations secretary general, says

physical therapy as we know it hasnot existed in China or Russia. WCPThas had contact with a number ofeducation programs in China, Myersreports, and were doing what we canto encourage the adoption of WCPTeducation guidelines there and facilitateestablishment of the profession and anassociation. In Russia, she says, whileseeds have been planted toward devel-oping education programs, there hasbeen little activity toward developing an

association.)

Almeida

Sommermeyer (standing) teaches neck evaluations in Iraq.

continued from page 27


10/11

Just as the level of PT education istrending upward worldwide, so, too, isautonomywhich exists in some coun-

tries in all WCPT regions, and is growing,Moffat says. That list includes, in additionto the United States (where PTs in moststates enjoy some degree of direct access),Canada, Australia, New Zealand, the UnitedKingdom, Ireland, South Africa, most ofthe Nordic countries, and Colombia.

Salaries earned by PTs are, of course,all over the global mapranging fromwhat the average PT earns in the US [amedian income of $80,000 in 20082] to

countries in which PTs make the equiva-lent of $3,000 to $5,000 per year, Moffatnotes. Its all related to standard of liv-ing and many other factors. To cite oneexample at the low end of that range,Sylvia Kambalametore says a government-employed PT in Malawi probably wouldstart at about $500 a month. Even bylocal wage standards, she says, thats con-sidered not so good.

Exciting to Moffat, however, is theglobal character of research being con-

ducted to provide evidence for PT

practice. The value of such research isemphasized in WCPT declarations ofprinciple on evidence-based practice,3

research,4 and education.1 The WCPTbelieves that physical therapists have aduty and responsibility to use evidenceto inform practice and to ensure that themanagement of patients/clients, theircareers and communities is based onthe best available evidence.3 It fur-ther emphasizes that research in physicaltherapy should encompass all domainsthat impact on the practice of physicaltherapy, from basic science through

health care policy, and that PTs have aresponsibility to share freely the resultsof such research through a range of dis-semination routes.4

In fact, physical therapists in manycountries are doing great research, Moffatsays. Indeed, nearly 60% of original sub-missions to Physical Therapy (PTJ), thepeer-reviewed journal of the AmericanPhysical Therapy Association, come fromoutside the United Stateswith submis-sions from Australia, Brazil, and Canada

leading the way.

Research is being generated aroundthe world that is relevant to the practic-ing physical or physiotherapist, says PTJ

editor in chief Rebecca Craik, PT, PhD,FAPTA. PTs worldwide benefit greatly, shenotes, by the aggregation of global researchat such Web sites as Hooked on Evidence(www.hookedonevidence.com), the Centrefor Evidence Based Physiotherapy (www.cebp.nl), the Physiotherapy EvidenceDatabase (www.pedro.fhs.usyd.edu.au/redirect.html), and the Canadian StrokeNetwork (www.canadianstrokenetwork.ca/eng/index_flash.php).

Carolynn Patten, PT, PhD, is enjoyinga preview of the next generation of inter-national researchers, teaching PTs fromabroad in the PhD program in rehabilita-tion sciences at the University of Florida.Citing the work of students from Italy,Switzerland, and India, she says confi-dently, these individuals are going to havea big scientific impact. Theyre going torock the world.

The world needs all the PTs it can get,observes Moffatparticularly given the

steady spread of what she calls the dis-

to which hes had access, however, quality of care, availability

of equipment, and expertise in using equipment vary greatly, he

says. Many times, if exercise equipment is available it collects

dust, because most physicians order only modalities. Iraqi PTs

have no national organization, he adds, and attempts to cre-

ate one are hampered by ethnic divisions and resistance from a

government-sponsored health workers syndicate that doesnt want

to lose its PT members.

In Turkey, Sommermeyer says, PTs education level is at least

a bachelors degree, with some masters and PhD graduates. But

in many developing countries PTs still are treated as technicians

by physicians in most settings and are not allowed to practice

autonomously. There are many rehab clinics and hospitals in

urban areas, but service delivery tends to decline in poorer areas

and among refugees.

Sommermeyer has witnessed some of the major challenges to

effective health care delivery in the developing worldincluding

government and private corruption, lack of cooperation among

international aid organizations, and trying to get people from

different religious, ethnic, professional, and socioeconomic back-

grounds to come together to solve a problem. But when physical

therapy works despite the obstacles in its path, beautiful things

happen.

Its rewarding when you see local people using the training

you have given them in the clinic to help their fellow citizens,

Sommermeyer says. Its rewarding when you see a person you

helped get a wheelchair go out into the community and vote

for the first time. Its rewarding when you clean and bandage a

wound for a person who walked 5 miles to get to the clinic. It

was rewarding attending a meeting where, for the first time, Iraqi

citizens with disabilities could come together to give voice to the

challenges they face and issue quality-of-life recommendations to

the new government.




11/11

32 S b

eases of civilization that are exacerbatedby sedentary lifestyles and poor diets.

Physical therapists are exercise

experts, ideally qualified to help preventor mitigate the effects of obesity, diabetes,cardiovascular disease, smoking-relatedproblems, pulmonary diseases, and somecancers, Moffat says. The enormity ofthe problem requires the efforts of every-one involved in health services delivery.The unsustainable alternative is spendingmore and more money on sicker andsicker people.

Changing LivesCelia Pechak, PT, PhD, MPH, an

assistant professor of physical therapyat the University of Texas at El Paso who is vice chair of the APTA Sectionon Health Policy and AdministrationsCross Cultural and International SpecialInterest Group (CCISIG; see sidebarbeginning on page 24), knows that eventhose APTA members whove taken thetime to read this article may question

what, exactly, international physical ther-apy has to do with them. Its the age-oldquestion posed by everyone from schoolkids to white-collar professionals sittingthrough mandatory seminars: Why do Ihave to know this?

Pechak ventures three reasons:v Need. There are approximately 650

million people with disabilities world-wide [according to the United NationsConvention on the Rights of Persons

with Disabilities]. Many if not most ofthem live in countries where there islimited or no access to physical therapyservices. Our assistance, in whateverform it takes, is critical. She advisesAmerican PTs to visit the Web sitesand resources of the WCPT, CCISIG(section membership is required), andHealth Volunteers Overseas, for start-ers, to see how to get involved.

v The profession. As we look towardVision 20205 and being a doctoring

profession, we must expand our rolein the global health arena. If we in theUnited States care about gaining our

rightful role in health care in our owncountry, establishing the professionsrole internationally goes hand in handwith that.

v Personal and professional growth.Getting involved in physical therapyinternationally really benefits thosewho care to get involved, Pechak says.Experiencing different care models indeveloped and developing countriesoffers PTs new knowledge and skills,

and exposes them to different practicepatterns that prove applicable backhome. Also, great advanced trainingis available via education programs inmany developed countries.Bill Romani, PT, PhD, ATC, SCS,

a senior research scientist at MedStarResearch Institute and an associateprofessor of physical therapy at theUniversity of Maryland, wrote anessay for the WCPT Web site titledHow a WCPT Congress Changed

My Professional Life. In the piece, hewrote that he felt compelled to becomeinvolved internationally after attending asymposium on physical therapy for tor-ture victims that had been presented atthe 2003 congress in Barcelona by clini-cians from South Africa and Zimbabwe.Romani now works closely with boththe WCPT and CCISIG to help get the word out about the role PTs can havein global health, and the opportunities

available to do so. He sees his niche ashelping developing countries establishor improve PT education.

Betty Kay, PT, PhD, says working asa PT overseas changed her life, too. Aresearch scientist at the RehabilitationInstitute of Chicago and assistant researchprofessor at Northwestern University,she received Health Volunteers Overseas(HVO) Presidents Call to Service Awardin 2006, which honored her 4,000-plushours of service in Vietnam and Uganda.

She also was instrumental in establishingHVOs physical therapy division.

Kay relishes every-

thing about her over-seas experiences, shesays, from the pro-fessional insights shegainedseeing yourpractices from a newperspective makesyou rethink what you

do, and why you do it that wayto thepersonal thrills of experiencing foreigncultures with colleagues who are natives. I

havent met anyone yet who had a negativeexperience, or who wouldnt do it again,she says.

Moffats journey to the WCPT presi-dency began in the 1980s, with volun-teer, consulting, and teaching opportuni-ties in Taiwan and Thailand. Now, in herspare time between teaching at NewYork University and maintaining a pri-vate practice, she jets around the worldin her WCPT role. If its Tuesday, thismust be Malaysia.

Im hoping to help advance our pro-fession in ways that will make peopleslives easier all around the globe, Moffatsays. I wouldnt trade this experiencefor anything.

Eric Riesis associate editor, manuscripts. He can be contactedat [email protected].

References1. World Confederation for Physical Therapy. Declaration

of Principle: Education. Available at www.wcpt.org/

node/29029. Accessed June 18, 2009.2. American Physical Therapy Association. 2009 Median PTSalary Information. Available at http://www.apta.org/AM/Template.cfm?Section=Surveys_and_Stats1&Template=/MembersOnly.cfm&ContentID=59484. Accessed June18, 2009.

3. World Confederation for Physical Therapy. Declarationof Principle: Evidence Based Practice. Available at www.wcpt.org/node/29552. Accessed June 18, 2009.

4. World Confederation for Physical Therapy. Declarationof Principle: Research. Available at www.wcpt.org/node/29461. Accessed June 18, 2009.

5. American Physical Therapy Association. APTA VisionStatement for Physical Therapy 2020. (HOD P06-00-24-35). Available at www.apta.org/AM/Template.cfm?Section=Core_Documents1&Template=/CM/HTMLDisplay.cfm&ContentID=25855. Accessed June18, 2009.

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