Overview of Placement

Interesting week to say the least. I'm still trying to get over the fact that there are no toilet seats, toilet paper or soap in the clinic. I guess I expected a little more in a clinic in a nice part of town where parents have to pay for the service, but I guess resources are still limited.

The clinic I will be an intern at is called ‘Toñito’ and was founded by a man named Dr. Silva. He had a child with developmental delay and decided to start this clinic for other children with brain disorders or injuries. The clinic is large and has one small room for Occupational Therapy, one small room for SLP, a classroom, a therapy pool (which is unfortunately freezing cold), several rooms for sensory stimulation, and 3 very large open area gym areas where I will be mostly working. This clinic is in a nice area of Lima and parents have to pay for the services. Having said that, much of the equipment seems primitive and the setting is not totally professional by our standards.

The experience has been very hands-on and the people are very welcoming and seem happy to have another set of hands. There is one doctor, 3 physiotherapists, one speech language pathologist, one occupational therapist and a teacher. I will be working alongside the physiotherapists to carry out therapy programs for various clients who are approximately 1 year to 18 years old.














The main gym where I will be spending most of my time will have up to 8 or 9 different clients working on various things. There are many assistants, volunteers, parents and nannies who also help with the therapy. One client can take up to 5 people to assist in an exercise. There is little in the way of charts, goals or paperwork of any kind for the clients. In that regard it is different than Canada.















My major challenge has been my struggle with the language. People speak very quickly, so I am constantly having to ask them to repeat things or slow down. However I have been able to communicate by acting and copying. The language will come in time, and I am able to learn the different exercises without too much trouble. The exercises are quite repetitive for each client, so once I have them all down, I will feel more confident.

Because of the language barrier, I am unable to get all the information I would like to about the specific reason behind each exercise. I want to ask why we are doing what we are doing (sometimes it is very clear, but often it is not).
Another difference from what I am used to is that the therapist does not meet for one child at a time for 20-30 minutes. They seem to haphazardly jump from one client to the next, then back again in what seems like no particular order. However, one thing that I have learned about Peru is that although things may seem highly disorganized and random, there is almost always a complex and intricate system that takes time to work out. I suspect that is what is going on at this clinic. There is a method to the madness, I just haven’t discovered it yet.

Some other issues that I struggle with are that most of the children hate the exercises and are literally forced to do them and they scream the entire time. It seems like often they are screaming for a reason and could possibly be in pain as some of the activities can be a bit rough (in my opinion). However, I have not worked in a therapeutic setting with children prior to this, so I cannot say if that is normal or not, but to me, it does not seem therapeutic or client centered. I question some of the methods used as they seem a bit archaic and contradict some things we have learned in school. For example, maintaining good posture and alignment while sitting with equal weight bearing on both sides was something that we learned to focus on and there were several occasions where this theory did not seem to apply while kids flop around on a ball while sitting in terrible alignment. But again, I am not an expert and I do not always know what the client is working towards so I am trying to leave my judgments at the door in order to adapt and learn.

One final issue that concerns me is the cleanliness. Assistants, volunteers and therapists go from one client to the next without washing their hands EVER. There is not even soap in the bathroom, let alone caviwipes or any sort of disinfectant to use to wash the equipment after it is used. Sometimes it feels like we overdo it in Canada, but this is definitely not okay!

After discussing all of the problems, I should also mention the interesting and exciting things I have seen. We work a lot on teaching children to crawl by first manually practicing hand over foot and hand, then teaching the child to go on all fours etc. This is very similar to what we learned in class, so it has been fantastic to make some connections from what I learned in school to what we are doing here in the clinic. We also work with clients on a ladder (which I apprehensive about) to climb up and down the ladder and swing (as if they are monkey bars) to practice grip strength, grasp and release as well as reaching. The part of this activity that I question is the way in which the child is held. Sometimes I think the arms are going to come loose from the sockets due to the lack of support of the body, especially children with low tone whose joints seem quite lax.

Also, there is an exercise on the ladder where the ladder is adjusted to mimic a seesaw. The child will climb up halfway, then the ladder will tip in the opposite direction and crash to the ground and will now be angled downwards so the child will crawl down.

We also work on equilibrium training, working on reflexes, core stability, getting up, and rolling over.

What I like about this placement is that it will be a unique challenge to learn the language and adapt to the methods used here.