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.

 
 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.