Stepping off the plane at Lilongwe International Airport in Malawi, doctor of physical therapy (DPT) students Alycia Clark ’17, Melody Mandell ’17 and Samantha Moore ’17 did not know the mixture of sorrow and joy they would experience during their stay in the east African country.
In the span of three weeks, they helped to identify three children with brain tumors.
“Our work in Malawi started on the first Monday morning with a referral for a child that had weakness on one side of his body,” said Casey Nesbit, PT, DPT, DSc, PCS, assistant professor of physical therapy. “The doctors assumed he had had a stroke.” Based on their neurological examination skills and pediatric clinical expertise, the group questioned that diagnosis. Instead, they suspected a brain tumor. During their time in Malawi, they examined two more children who presented with similar symptoms.
“Our classroom experience gave us great tools to help direct us towards the diagnoses of brain tumors,” Moore said. “We are fortunate to have a class dedicated to diagnosis that helps us identify what we call ‘red flags.’”
Added Clark: “We have had wonderful professors who, throughout our coursework, have asked us to critically analyze patient cases.”
Physical therapists are trained to analyze movement and identify functional limitations. “[We are] movement specialists, with expertise in analysis of human movement and knowledge of how the body works,” explained Preeti Deshpande Oza, PT, PhD, NCS, assistant professor of physical therapy.
“Throughout the DPT program, students learn to do assessments, use the correct tools for patient examination and do differential diagnosis to identify the cause of movement dysfunction, in order to provide the appropriate interventions,” Dr. Oza said.
Throughout their time in Malawi, the students listened and gathered information before giving their input or recommendations for patient care. “The students learned to respond to the needs that others brought to their attention,” Dr. Nesbit explained.
“The education about brain tumor awareness will always be a part of their medical protocol. That is an amazing gift to a resource-limited setting.”
They also learned first-hand the challenges and opportunities that come with cross-cultural communication. “Though it can be really frustrating not being able to communicate in detail due to a language barrier, it is surprising how much can be communicated through other methods,” Mandell said. “Things as simple as eye contact, compassion and open body language can communicate enough for complete strangers to know that you genuinely care.”
Dr. Nesbit quickly recognized the necessity of establishing a screening protocol to identify pediatric patients with brain tumors so that the Malawian health care works can help these patients get the treatment they need. Developing the protocol was a collaborative process which took into consideration the resource limitations. At the time, the country had only one working CT scanner and one neurosurgeon.
Dr. Nesbit worked closely with Malawi’s only neurosurgeon, Patrick Kamalo, a Malawian trained in South Africa. “He performs three to four surgeries every morning on children with brain tumors,” Dr. Nesbit said. “With his wealth of experience in developing countries, he said he thought that the reason why we were seeing more children identified with a brain tumor was not because their numbers had increased, but because they were better identified.”
By developing a protocol for brain tumor identification, Pacific students made a lasting impact that extends far beyond the patients they interacted with during their time in Malawi. “The education about brain tumor awareness will always be a part of their medical protocol,” Dr. Nesbit said. “That is an amazing gift to a resource-limited setting.” She told the students, “‘Look what you left behind. You gave them something, you empowered them.’”
The experience had a profound impact on the students. “It was a truly amazing experience that changed my life and the way I look at the world,” Moore said. “I take my experience to heart and carry it with me throughout my day as I continue to work with patients in the United States. My favorite thing about Malawi was the people. They were open to us as students coming in from another country and providing them with care and education. They were all so friendly and I was never made to feel out of place.”
Clark and Mandell echo her sentiments. “The experience has truly changed my life and has changed the way I interact and view patient care,” Clark shares. Added Mandell: “I learned so much from the health care workers we partnered with in Malawi. They have an incredible work ethic and their sense of community has inspired me in my career as a physical therapist.”
By Anne Marie H. Bergthold