My husband Dave and I returned from breakfast this morning to find a
large envelope from the Vietnam Office of the World Bank on the doorstep
of our Da Nang townhouse. In English, atop the single enclosed page
were the words: "Innovation Day, Traffic Safety," so we know that this
message refers to the grant application we submitted a month ago
requesting assistance in covering part of the expense of providing
motorbike helmets for each of the 3079 employees of the Da Nang Health
Department. However, the text of the message is entirely in
Vietnamese. Dave and I can identify some words: "I", "we", "very", and
dates—but the bulk of the message is a mystery to us. Dave is
attacking it now with the aid of his pocket Vietnamese-English
dictionary and I am sitting across the room, writing and reflecting on
how we arrived at a situation in which we have committed to a
twenty-three thousand dollar project on behalf of Steady Footsteps, an
organization that is, at the moment, without funds.
This episode is consistent with what Dave and I have been doing for the
past year and a half: Stepping Out on Faith. In 2005, we took a big
step in deciding to quit our jobs, sell our home and move to Vietnam.
Committing to the legal process and expense of setting up our non-profit
organization, Steady Footsteps, was another big step. And yet every
day, here in Vietnam, I find myself taking small steps on faith. Each
day I arrive to volunteer at the Da Nang Rehabilitation-Sanatorium
Hospital without a specific agenda. Every time I insert myself into a
specific situation there and open my mouth to speak, I consciously try
to center myself and be a channel for truth and for blessing. That
might sound pretentious, but it's true. This was not the way I was
living back in America. But here, I can be my own best self. Not so
much by intention but, rather, by following incremental leadings-- step
by step--I've developed a lifestyle which allows me to live a better
centered and more conscious life than I ever did in the US.
Life in Vietnam, for me, is less stressful than was my previous American
existence. I no longer have a house to maintain. I don't cook and I
rarely shop. I don't even drive. My commute to work is one mile each
way, seated on the back of my translator's motorbike. There's a lot to
be said for simplicity. A less cluttered life allows me more time for
reflection; for reading and writing. And I find that when my own life
is not so pre-programmed and anxiety-driven, that it's easier to pay
attention to, and act upon, feelings of empathy and generosity.
I work limited hours at the rehabilitation center. I set this up
intentionally as I want to be a mentor for the Vietnamese physical
therapists and physical therapy students, but I don't want to assume
primary responsibility for the care of their patients. I want the
therapists to learn to be better clinicians; I don't want them to
abandon their patients to my care. Another result of this more limited
schedule at the hospital, however, is that my work never becomes
routine. I am able to observe and respond to situations there with a
fresh perspective.
I am not scheduled by supervisors, nor am I responsible for revenues or
documentation at the hospital. I can move about and interact with
whatever therapist, student, patient or family member seems to need my
help. This, more than anything else, I believe, allows me to be in the
right place at the right time.
I can't speak casually with any of the hospital staff or patients as
none of them is fluent in English and my command of Vietnamese is not
remotely equal to the task of communicating what I know about the art of
physical therapy. I must rely on my translator. I have to carefully
consider how my words might be interpreted and there are long pauses in
any discussion to allow for the translation process. These pauses and
this awareness of the tenuousness of verbal communication give me a lot
of time and opportunity to "Be Here Now." I have much more opportunity
and incentive to study people's body language and facial expressions.
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I have been amazed, for example, at how easy it is for me, even as an
English speaker, to recognize when a brain-injured Vietnamese patient
has receptive aphasia (difficulty understanding his own language). I
can even distinguish between someone who has dysarthria (difficulty
producing the sounds of speech) vs. expressive aphasia (difficulty
recalling words). And yet what seems obvious to me, as an experienced
therapist, is not at all apparent to the minimally experienced PT's with
whom I work.
It occurred to me yesterday that the essence of what I want to teach is
not in any physical therapy curriculum. I didn't even articulate it
very clearly when I wrote the original mission statement for Steady
Footsteps. Here's what crystallized that realization for me.
Yesterday morning, I walked into the physical therapy gym and saw a
young man with a deformed skull strapped down on a high, narrow
treatment table. His therapist, a tall, handsome young fellow named
Lam, was vigorously and repeatedly flexing his patient's leg. The
patient's face was twisted with pain; the therapist was staring off into
space.
"Hey," I said, "do you realize you're hurting your patient?"
"Well, I told him to tell me if it hurt him. He didn't say anything," responded Lam.
"Is this man really able to speak?" I asked, looking quizzically at
the young man who was obviously paralyzed on his right side.
(Right-sided paralysis is often associated with language difficulties.)
"Well, no, he doesn't talk much," admitted Lam.
"So how is he supposed to tell you that you are hurting him? I
don't speak Vietnamese, but I can look at his face and see pain there.
How can you know what is going on if you are not even looking at him?
You are trying to increase his range of motion. In order for you to
effectively stretch his tight muscles, he must relax. He cannot relax
if he is in pain. Watch his face as you work with him and you will
learn how to help him without causing him pain."
I felt that I had made my point and went on my way. Later, however,
I returned to find the patient, again strapped down on the table,
looking more distressed than ever. This time, his therapist was looking
directly at him and laughing.
"What are you doing?" I asked. "You know that this brain-damaged
young man does not understand why you are doing these things to him. He
is feeling discomfort and yet you look at him and laugh! What can he
be thinking? Does he think that you care about him and that you are
trying to help him? I don't think so. When he is strapped down on
that table he feels helpless and frightened and, to be honest, I don't
think that performing passive range of motion is the best use of your
limited time with him. Let's try something else."
With that, we helped the young man off the table and sat him down on a
straight-backed wooden chair. I pulled up another chair directly in
front of him. Lam and Mieng, my translator, stood to one side. Looking
directly into the young patient's eyes, I smiled and held his hand
gently. He smiled back. I helped him arrange his unruly feet flat on
the floor. And then I pantomimed that I wanted him to stand up.
Counting loudly to three in Vietnamese, "MOT, HAI, BA!" I helped him
rise to his feet. I held him there and helped him shift his weight so
that it was more directly over his relatively strong left leg. After
about 30 seconds, we sat down. Each time we stood up, he seemed to "get
it" a little more and make a more effective effort to arise and find
his own balance. And each time I smiled at him and praised him
profusely. It didn't matter that I was prattling on in English—he
understood that I cared about him and that I was pleased with his
efforts and, by the time we had completed our session, he was beaming
broadly.
So what were the lessons of the day? "Being Present in the Moment."
"Compassion." Traditional concerns in both my own Quaker faith as
well as in my husband's chosen path of Buddhism. You won't find them
listed in any physical therapy curriculum, but what other lesson could
be more essential for a therapist—or for any other human being?
Addendum: Dave's translated enough of the
World Bank letter for us to realize that we are out of the running for
the grant money that we had hoped would help cover the twenty-three
thousand dollar cost of the Da Nang Health Department Motorbike Helmet
Project. Oh well. We still feel led to complete this project. We
still believe that this project has the potential to help stem the
epidemic of traumatic head injuries that is sweeping across Vietnam.
So we will, again, "Step Out on Faith" and order those helmets from the
ProTec factory in Hanoi. We would like to invite anyone who feels led
to do so, to please contribute to Steady Footsteps, in order to not only
help us finance this specific project, but also our other, more modest
ones: providing plastic ankle braces (AFOs) and other assistive
devices for disabled patients and providing the services of a reliable
translator for any therapist who is willing to come and volunteer with
us here in Da Nang. And if you should happen to know of any
compassionate, functionally-oriented physical or occupational therapist
with a ready ability to "think outside the box" and a special affinity
for upper extremity rehabilitation of brain-injured and quadriplegic
patients, please suggest that they contact me at
valockett@gmail.com I would welcome their insight and, should they be adventurous enough to visit Vietnam, I'd be glad to help them arrange a meaning-filled visit with the rehabilitation community of Da Nang.