Moving Right Along

In the fall of 2007, two Madison physical therapists, Jacque Polorney and Nancy Wilke, accompanied Lisa Fernandez to Nicaragua and shared their skills and enthusiasm with both children and older adults in SRW supported programs. They gave and learned, assessed and taught, moved and danced, shared and connected. Following is Nancy’s account of their time in Nicaragua.

On Nov. 2, 2007, Jacque Pokorney and I arrived in Matagalpa, Nicaragua and met Mercedes and her three children, our host family for the next five days. The cobblestone road to their house was so steep that our driver had to back the pickup truck up the street, to best use the rear wheel drive. Mercedes works at Familias Especiales, a program that offers services for handicapped children and their mothers and which receives material support from SRW. She was a wonderful host and generously opened her simple home to us. Jacque and I enjoyed the sweetness and friendship she and her children extended to us.

Her brick house, like many in Central America, is in a constant state of construction and repair. It has three levels, with a dirt path connecting the levels to the back yard. The top level is the main living space, a combined dining/living room and a kitchen/bathroom. The bathroom consists of a toilet in a stall partitioned off by a curtain. The shower stall is next to the toilet and separated by a concrete wall. Flushing the toilet involves dumping in a bucket of water from the hose in the kitchen—the only water source in the house. Showering was done using a small pail dipped into a large plastic tub on the fl oor, which was fi lled by the hose. Next to the shower is the typical concrete sink, where all the household laundry is hand washed.

The day after our arrival, we walked over to the complex of buildings that house Familias Especiales and met a group of Spanish physical therapy students who were volunteering for several months. We also met the local Nicaraguan physical therapist, Gustavo, who coordinates the physical therapy program that Familias Especiales offers. Their program includes therapy at the center, home physical therapy for kids unable to be brought to the center, and horseback therapy conducted on land with horses donated by a well-to-do local coffee farmer. Gustavo had learned horseback therapy techniques in Spain and returned to Nicaragua to implement this program—the only one in the country—for Familias Especiales. He also made the connections with the Spanish physical therapy school for a student internship program which brings regular volunteers to Familias Especiales to learn and work.

Our day started early, as we drove from house to house in the Familias Especiales van, picking up the children and their mothers who were going to horseback therapy. They emerged from tiny, simple brick and corrugated metal homes, but each child was freshly bathed and dressed with pride in neat, pressed clothes.

Hippotherapy (horseback therapy) involves the child sitting astride the horse outfitted with saddle and reins, while the therapist walks alongside to give whatever assistance the child needs to stay balanced in the saddle. As an assistant steadies the horse, the therapist places each child in the saddle and off they go. The students from Spain and Jacque and I assisted with positioning and stabilizing the riders. As the children are placed on the horse, their trunks straighten and their heads rise gracefully above their spine with a look of pride, confidence and joy. Each child rides along a dirt track and up and down a hill for several minutes and no one wants it to end. The rhythmic grace between horse and child is a vision of hope for more independent mobility.

Another afternoon, Jacque and I assisted in the physical therapy clinic at Familias Especiales. Mothers brought their children in and we worked with one child after another on the mats and on the balls, seeing children with neurodevelopmental delay symptoms such as hypotonia, poor head control and the inability to roll, sit or crawl. Working side by side with the mothers is most important so they can learn the therapy and daily handling skills that can facilitate more functional movement in their children’s everyday activities.

On Nov. 7, we were driven to Jinotepe, Nicaragua and met our new hosts, Raphael and Patricia Manzanares, a retired couple who had lived and worked in Palo Alto, Calif., for thirty years. They are now working with Guillermo Monguia, a theologian from Jinotepe, who raised money for and built El Hogar de Ancianos (the Old Folk’s Home) several years ago out of dismay at the situation of the many homeless elderly wandering and sleeping on the streets of his hometown. The Hogar was built in a grove of trees, designed in a U-shape with a central patio and covered walkway. One wing has the women’s rooms and the other the men’s, with a couple of quiet resident rooms to the side. Along the base of the ‘U’ are the kitchen and dining rooms, the laundry room, the offi ce, a small pharmacy and the main entrance. Chickens pecked in the backyard and one resident wandered the grounds with his goat.

Jacque and I have each been physical therapists for many years, both of us specializing in geriatrics, so we felt right at home at the Hogar. On our fi rst morning we held a group exercise session with all 28 residents seated in a large circle in Ël Rancho, a round covered patio with open walls. Traditional Nicaraguan music played on the boom box, and we encouraged each person to stand, sway to the rhythm, greet their neighbors, raise their arms overhead, kick their legs, turn around and move to the beat. Some were quick, mobile and expressive. Others were very shy and physically impaired. Jacque and I gently persuaded each to come to their feet and move to the music. One gentleman, Alonzo, was a quadriplegic and was quite surprised to find himself helped to stand and dance, fl anked and supported by two tall, strong women. Esteban, an 80-year-old woman with Parkinson’s disease, found herself relaxing and stretching with a little assistance. The therapy balls came out and a wild session of roll, bounce and catch ensued. These beautiful elderly faces smiled, their bodies moved, they were touched and hugged and each one received attention. Although our Spanish skills were poor, we were able to communicate through music, movement and touch.

The next day we evaluated each resident individually, assessing ways to enhance their mobility. We made recommendations for each to Guillermo, the administrative director, and the staff. The majority of the staff at the Hogar are young women with families, untrained in formal medicine. They lovingly help to bathe and dress the residents, change beds, clean rooms, bathrooms and hallways and launder all the clothes and bedding every single day! The staff discussed residents who were diffi cult to transfer or care for, and we problem-solved solutions. Although the needs are great, the residents’ basic daily needs are met with compassion, patience and humor. The staff members do this work 10–12 hours per day, six days a week, for approximately $50 per month. One of the most crucial needs of the Hogar is to somehow be able to increase the staff salaries (which are even below the minimum wage for Nicaragua) in order to motivate and support the staff. They give so much of themselves to the homeless elderly, in a country where living conditions are so marginal. It was a very rewarding experience to see the people supporting each other, where the government gives so little support to the poorest of its own citizens.