52JUNE 2015 www.oandp.com/edge

STUDY ABROAD PROGRAM

SERVICE LEARNING WITH AN O&P

By Maria St. Louis-Sanchez

53JUNE 2015 www.oandp.com/edge

The new study abroad program at the univer-sity came about due to student requests. Students Sara Lustusky and Amanda Gilarski approached Santiago Muñoz, CPO, the Pitt MSPO orthotic coordi-nator and an orthotic and prosthetic instruc-tor, and co-owner of an O&P practice in Ecuador, with their idea. Lustusky and Gilarski say their instructor loved the idea. Lustusky says that although they didn’t know what shape the program would take, they thought that with Muñoz’s international connections he would be a good person to approach with the idea. “He was all for it, was really enthusiastic, and immediately he said, ‘All right, let’s do this.’”

Muñoz says it makes sense for O&P students to learn more about

the profession abroad and the patients served. “Right now we are living in a world with the globalization of everything,” he says. “Our students in O&P should not only be looking at issues here, but they should be thinking about global issues and conditions as well.”

Muñoz immediately began developing a program. Since he was already organizing a Latin American forum for the International Society for Prosthet-ics and Orthotics (ISPO)—the 6th Unit-ing Frontiers Forum in October 2014—he decided to arrange the study abroad trip around the forum so the students could talk with practitioners from around the world. He also thought it would be important for the students to put their

skills to the test. He contacted his practice in Ecuador and asked people there to be on the lookout for patients who needed help. With the plan in hand, he submitted the proposal to the university.

“�e project was approved by the university, and it was considered an o�cial study abroad program,” Muñoz says. He and six students planned to go to Ecuador, spend a week treating patients, and attend four days of the conference. As an o�cial study abroad program, the students were indi-vidually evaluated on their application of key elements of the MSPO program, which included ethical issues in healthcare, evidence-based practice, clinical pathology, biomechan-ics, materials, equip-ment, and fabrication, to earn college credits.

An Unfamiliar Country and LanguageFor many of the stu-dents, a big part of the challenge was simply being surrounded by another culture; even a trip to the grocery store was a culture shock for Gilarski, as it was her �rst time traveling outside of the United States. Translators were available to help the students bridge the lan-guage barrier, and yet it could still be di�cult to �gure out exactly what their patients were thinking and feeling,

Sometimes the best lessons in the O&P profession can’t

be learned in the comfort of your own country. That’s what

students in the University of Pittsburgh (Pitt), School of

Health and Rehabilitation Sciences, Master of Science

in Prosthetics and Orthotics (MSPO) program say after

treating patients and attending a professional conference in

Ecuador. And they say that they hope other O&P students

find ways to test their comfort levels by working in cultures

that are different from their own.

54JUNE 2015 www.oandp.com/edge

the students say.“We learned how to

use our intuition a lot, and you really had to challenge yourself to �gure out what was go-ing on,” Lustusky says. “We had translators, but diagnostically, you had to use your powers of observation.”

While it was a chal-lenge, it was also the point of the trip, says Leah Wolfe, another MSPO student.

“[I] went on the trip because I thought it would be an excellent opportunity to hone my patient skills,” she says. “I wanted to learn how to address people from di�erent cultures and help them to the best of my ability.”

Another lesson the students took away

was the di�erence in materials used by the O&P professionals in Ecuador. “It costs them too much to import the plastics [we use in the United States], so they have to use di�erent fabrication techniques,” Gilarski says.

The PatientsMuñoz used his con-tacts to line up patients in Ecuador for the students to assist— patients who were not able to get O&P care otherwise. �ey helped a marathon runner �nd a better running solu-tion, they helped cast a patient with a hip dis-articulation, and they �tted three patients with cerebral palsy with six orthoses. �ere were also two other patients, however, who the students say made the biggest impact on them.

�e case that was the most emotional for many of the students was an 18-month-old girl with a congenital condition that kept her from developing knees and legs beyond her femurs. Lustusky says that the girl was falling a lot but was unable to receive basic prostheses from the government because her physician

decided she wouldn’t need assistive devices until she was 15 years old.

“�at kind of blew us away, and we didn’t really understand the reasoning,” Lustusky says. “Basically her parents went online and sought help. �ey weren’t going to take no for an answer.”

�e students casted the girl for stubbies and �tted her residual limbs with pediatric gel liners. At �rst, the child screamed because she didn’t understand what was going on, says Wolfe. �e parents became worried because of her reaction, and Muñoz had to calm them. He reassured them that she was crying because she was confused and had never had this experi-ence before, Wolfe says, not because she was in pain.

In the end, it worked out. �e students were all there when the tod-dler stood on her own for the �rst time.

“Her mom cried when she saw her stand for the �rst time; it was a beautiful moment,” Lustusky says. By the end of the week, the girl was crying when

“Right now we are living in a world with

the globalization of everything. Our

students in O&P should not only be

looking at issues here, but they should

be thinking about global issues and

conditions as well.” — SANTIAGO MUÑOZ, CPO

Left: Wolfe and Lustusky assess a patient with polio as part of the study abroad program.

Right: From left, Briana Suppes, Kelly Harkins, Wolfe, Lustusky, David Ortiz, and Gilarski pose with a patient athlete.

Photographs courtesy of Santiago Muñoz.

56JUNE 2015 www.oandp.com/edge

she wasn’t wearing the prostheses, Wolfe says, and was asking for her zapatos, her shoes.

Another case that af-fected the students was helping to improve the life of a polio survivor. When he arrived, the 56-year-old man was using bilateral forearm

crutches to walk. �e students observed his knees bending backward, measur-ing between 40 to 45 degrees.

“He was an active person, but walking for him was exhausting,” Lustusky says.

�e students say they were challenged by the case. In the United States, polio has been eradicated for so long that patients with those kinds of mobility issues are rare. To help him,

the students fabricated bilateral KAFOs and adapted the braces to accommodate for his plantar�exion contrac-tures.

�ey weren’t there for his �nal �ttings but watched by video as he tried on his new braces and walked down a hallway. A later video showed how he had progressed to walking with just the aid of a cane.

“His quality of life has improved signi�-cantly,” Lustusky says. “It’s incredible that something we made was able to do that for this gentleman.”

Overall, the students say that working with patients abroad brought home the overall process of what their jobs would be like. For one of the �rst times, they got to see a patient through the entire process.

“We had a fantastic setting in which we could accomplish a lot in a short amount of time,” Lustusky says. “In clinicals, you see snippets of a patient’s life. But because we were with the same patients almost every day for a week, we got to see everything from

start to �nish….”�e hands-on experi-

ence was so impactful that Lustusky, with the support of David Ortiz and the rest of the students, submitted the polio patient experience as a case-study abstract that was approved as a poster presentation for the ISPO 2015 World Congress in Lyon, France, later this month.

The ISPO Conference Helping patients was just part of the pro-gram. Muñoz also wanted the students to learn from interna-tional O&P profession-als. “My intention was to expose them to the challenges of practi-tioners from other parts of the world,” he says.

Wolfe says she real-izes that even though some things were di�erent, O&P profes-sionals in the United States and Ecuador share many of the same challenges.

“We are all hav-ing problems being recognized as medical professionals instead of as durable medical equipment suppliers,” she says. “I was able to talk with a lot of

“We learned how to use our intuition a lot,

and you really had to challenge yourself

to figure out what was going on. We had

translators, but diagnostically, you had to use

your powers of observation.” — SARA LUSTUSKY

Left: An 18-month-old girl with bilateral congenital conditions was treated by the Pitt MSPO students.

Right: David Ortiz, second from left, evaluates a patient with cerebral palsy in a physical therapy center in Ecuador as others assist.

58JUNE 2015 www.oandp.com/edge

di�erent practitioners and hear that they were all pretty much on the same page. I was glad to see that we are all looking to the future of our �eld and [how to] make it better for our patients. It was an invalu-able experience for me.”

Gilarski says she saw that even though the healthcare systems of the United States and South America are di�erent, there are still a lot of similarities. “�ey had a di�erent kind of healthcare system…but just talking to them showed me how passionate they were to get a high standard of care for their patients, which really inspired me.”

Lustusky says that talk-ing with the professionals

helped her learn about how she wants to ap-proach her career. She sees herself continuing to give aid abroad, but convers-ing with the professionals helped her realize that this assistance can be provided in an inappropriate man-ner, no matter how well-intentioned it might be. “What I learned from the conference was to be aware and conscious of the ethics when you go about helping out cultures you might not understand,” Lustusky says. “It’s not about going in and making yourself feel good. Because I don’t live there, part of my job will be to make sure [that] the soci-ety will be able to sustain itself so eventually they won’t need outside aid.”

A New Way of ThinkingBeyond the learning expe-rience and helping others, the students and their instructor say one of the best things they got from the experience was their problem-solving skills.

Student Briana Suppes says she has already put her new skills to work. At an externship she went to a�er the program, she chose to use a speci�c joint on a KAFO in the same way she had seen it used in Ecuador. “�ey [asked], ‘How did you think to make it like that?’” she says. “We learned how to do things that we wouldn’t have thought of originally.”

She says that she and many of the other students

plan to return and hope to see their patients again, especially the toddler. “We have every intention of go-ing back and seeing those patients again and again,” she says. “We’ll get to see how the little girl grows up through the years.”

Experiences like these are the beauty of such programs, Muñoz says. “By studying abroad, it led [the students] to think about other possible treatments and other solutions that they may have never realized oth-erwise. It will help them grow into well-rounded practitioners.” O&P EDGE

Maria St. Louis-Sanchez can be reached at msantray@yahoo.com.

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