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Barefoot in Honduras

by Richard Graham(more info)

listed in physiotherapy, originally published in issue 141 - November 2007

In this article I give an account of a recent teaching assignment in a rehabilitation centre in the town of Danli, Honduras. During my five week mission I taught a team of Physiotherapists a series of Yoga exercises and Shiatsu techniques that can be used in rehabilitation therapy. I also introduced an Acupuncture protocol for the treatment of stroke that will be expanded into a research project next year. Honduras is situated in Central America and is the third poorest country in the western hemisphere. Widespread malnutrition is responsible for 34% of the children experiencing stunted growth between the ages of two and five. Rehabilitation and Physiotherapy services are minimal. Government clinics often lack adequate personnel, equipment and supplies. Population growth,and the present lack of facilities, seem to suggest that public health services in Honduras are likely to remain inadequate for the foreseeable future.

The medical volunteers with the two American doctors (left)
The medical volunteers with the two American doctors (left)

About Myself

I am a Shiatsu therapist, Acupuncturist and Physiotherapist registered with the Health Professions Council. I work in private practice and a GP practice in Suffolk. I teach at the College of Traditional Acupuncture, Warwickshire, which is affiliated to Oxford Brookes University. In 2001 I joined International Medical Volunteers Overseas and worked on assignments in China, Mongolia and Indonesia. In 2004, I received both personal and written commendations from His Royal Highness the Prince of Wales for my efforts in the integration of Western and Complementary medicine. In 2005, following the Asian tsunami, I set up the charity Physiomed Overseas to provide rehabilitation therapy to the poor, the sick and the disabled overseas.

Life in Honduras

The shot gun went off a few feet from my head. Fortunately there was a plate glass window between me and the armed guard who had fired the shot. I was in a roadside diner at the time eating a sandwich. The armed guard was outside protecting a security van. He had fired his gun as a warning to a group of thugs who appeared on the scene in a beaten up station wagon. The thugs changed their minds and turned tail. The security van and the guard headed off in the opposite direction. This was my first day in Tegucigalpa, the capital of Honduras, a country that has a rising crime rate ten times higher than the United States.

Purpose of Visit

I was invited to Honduras by Kathy Rubio, an ex-Chicago paramedic, who set up a medical clinic in the town of Danli shortly after Hurricane Mitch devastated the country in 1998. Kathy runs the clinic with medical volunteers who come from all parts of the globe. Kathy read about my work for Physiomed Overseas that I set up after the Asian tsunami and asked if I would be prepared to come out for a month to help her, and also spend some time training staff at the local rehabilitation centre. She wrote to me beforehand to warn me that the rehabilitation centre had little equipment and that most of my teaching must be based on ‘hands on’ therapy. I relished this challenge. It is always a wonderful experience to practise all of those techniques that I have at my fingertips that don’t cost a penny!

I always pay my own fares and living costs when I work as a volunteer. Any money that I raise for my charity Physiomed Overseas goes directly to the needs of the patients. For this trip I took a range of joint supports (as I had been warned there were a lot of repetitive stress injuries), over 1,000 Acupuncture needles, strappings and bandages, a model of the human spine and all of my yoga books. Within a few hours of landing in Honduras I was working as part of Kathy’s medical team that comprised two doctors from America and two dental students from Sheffield. All of us were volunteers. Conditions we worked in were often reminiscent of scenes from Mash (the American TV series) as we travelled into the remoter parts of Honduras where medical facilities are scarce. The first time we did this our theatre of operations was a Catholic church. The two young dentists dressed in face masks, goggles and Bermuda shorts performed complicated oral surgery using head torches and a plastic chair where they would normally have overhead lighting and a hydraulic couch. As for me, I used the church altar as a treatment table for my shiatsu and acupuncture. One has to be resourceful in these situations (and I hope that God has a sense of humour and a tolerance of Daoism)

During these excursions, nicknamed ‘Brigades’, I treated a stream of back problems, joint injuries and repetitive stress injuries. Bread and butter stuff for UK therapists, and most of these conditions were straightforward to treat with shiatsu mobilization techniques, yoga exercises or acupuncture. But paralysis following gun shot wounds, adolescents that have suffered stroke, stunted growth from malnutrition, deformity in fractured limbs that have never been set properly? These were problems that I am unlikely to come across at home and tested all of my skills and resources. On my second day in Honduras I had to bind a ten year-old who had fallen out of a tree and fractured his collarbone. A week later I had to treat a farmer’s wife who had fractured her forearm but could not afford the cost of going to a hospital; I was glad that I had kept up with my study of First Aid in the UK. Working in Honduras tested my resources. Fortunately my acupuncture is a passport into any medical territory and whenever my physiotherapy skills seemed inadequate, my knowledge of Acupuncture always gave me a direction, especially in the treatment of chronic pain and mental trauma. I was even called upon to treat one of the British dentists in our team who developed a mysterious and prolific rash on both arms. From the perspective of Chinese medicine this condition is caused by an invasion of wind and heat, and is treated by using points to release this pathogen.

Acupuncture on the altar in the Catholic Church
Acupuncture on the altar in the Catholic Church


When I was not doing Brigade work for Kathy Rubio I spent my time training the physiotherapists at the Danli rehabilitation centre. Danli has a small hospital but no physiotherapy department, and the rehabilitation centre caters for a population of 180,000. The team of six therapists led by Anselmo Rodriguez is run by a charity funded by local business people. There are no Osteopaths, Chiropractors, Acupuncturists or qualified Alternative Practitioners in the area, and the local population is reliant on Anselmo and his dedicated team. To put the enormity of their task in perspective, I always compare the resources available to the people of Danli with the resources available to the people of my home town near Ipswich. In Danli there is one therapist per 30,000 people. In Ipswich there is approximately one therapist per 300 people.

State of Danli

Why is Danli so under resourced? Quite simply the health services in Honduras are under funded. The country is the third poorest country in the western hemisphere, and most Hondurans live in poverty. Why is this so? Guidebooks tell us that Honduras is a stunningly beautiful country with a tremendous potential for tourism, and that there are eight different ecosystems that include rain forest, cloud forest, coral, mangroves, wilderness and swamplands. There is a very active group of conservationists within the country who are trying to preserve this incredible environment and bolster the country’s economy through tourism. Their task is not an easy one, and they are finding it difficult to convince their countrymen that the short term profits from slash and burn farming, timber deforestation and intensive cattle ranching is not the way to long-term prosperity. Those far sighted enough to see past the next strike of a match realize that the way to improve the living conditions of the seven million inhabitants of Honduras is through tourism. Unfortunately, the total number of tourists that visited Honduras in 2006 was less than it was in 1998. Then it was four million. Now it is two million. The reason for this may have something to do with Hurricane Mitch which devastated the country in 1998, but it is more likely to be the result of the alarming crime rate in Honduras – ten times higher than the US and rising. One American guidebook compares the capital of Honduras, Tegucigalpa to ‘downtown Baghdad’. Most Hondurans carry guns, and it is unsafe for a ‘gringo’ to wander out at night. Poverty is, of course, the root of the problem that is the legacy of a weak agricultural economy. There is little industry in Honduras, and drugs, arms trafficking and robbery are the growing economy here. Gangs set the rules and guns, and machetes are the tools of their trade. This, coupled with the fact that Honduras is tainted by its past associations with Guatemala, El Salvador and Nicaragua, doesn’t paint a pretty picture for the discerning entrepreneur, or visitor, who prefers to take their investments and their holiday money to the safer shores of nearby Costa Rica.

A weak economy has a knock-on effect in any society, and at the rehabilitation centre in Danli the lack of public funding means that Anselmo and his team of physiotherapists have minimal equipment and are totally reliant on handouts. They have no ultrasound or interferential apparatus, all standard equipment for physiotherapists in the UK. All that is available to them are heat pads, ice packs and three old Tens machines that were donated by a visiting American doctor. When I asked Anselmo what equipment would help him in his work he told me that he prays for some exercise equipment to help with the rehabilitation of stroke patients. A second hand ultrasound or interferential unit would be of even greater benefit.

My reason for writing this article is in the hope that someone will answer this prayer.

Treatments at the Rehabilitation

Despite the absence of modern equipment, the physiotherapists do a remarkable job. They are dedicated and gifted individuals. They get good results. They use heat, cold, their hands and exercise techniques. They inspire their patients with good humour and hope. Enthusiasm, commitment, and their hands, are their greatest tools, and it was a joy for me, with my own ‘holistic’ background, to work with them. Part of my small contribution to Anselmo and his team was to teach them some yoga exercises for their patients, and introduce them to shiatsu mobilization techniques. These techniques are very similar to the Maitland mobilization techniques taught to qualified Chartered physiotherapists, and are simple and safe methods for the treatment of most joint problems. Anselmo and his team put a lot of reliance in hot and cold packs for the treatment of most injuries, particularly low back pain and sciatica, and they were very interested in my own theory that most back pain comes from compression of the spinal joints. When I demonstrated some of the Shiatsu and Yoga stretches for relieving compression they were very quick to put these into practice. The decompression exercises of Sarah Key, in which patients lie over a block of wood to unbind stiff spinal segments, took a little bit longer to be accepted, but by the time I left Danli the team were also using these techniques. In my opinion, Sarah’s decompression exercises are as good as any traction machine and provide an effective and inexpensive way to treat neck, thoracic and lumbar problems. I also trained one of the physiotherapists to use a very simple acupuncture protocol on patients who have suffered a stroke. Rosa was the Physiotherapist’s name and, together, we practised the art of needling for several hours using an orange as a ‘recipient’. Rosa learnt quickly and was soon needling real patients. Together we were able to set up a pilot study. In January I will return to the clinic and expand this study into a research-based project to study acupuncture as a primary therapy in the treatment of stroke. This could have significant repercussions. Currently in the UK the western medical treatment of stroke concentrates on prevention by treating the disease conditions which predispose to stroke. After a stroke has occurred immediate treatment focuses on stabilizing the patient and keeping them alive. Thirty-five per cent of patients die in the hospital, and those who survive are generally referred to Physical Rehabilitation Therapists. However, there is no conclusive evidence to prove that rehabilitation improves recovery rate, and it may have little more than a placebo effect. In China, Acupuncture is given as part of primary care to stroke patients, and the anecdotal evidence from that country suggests that the survival and recovery rate of these patients is better than their western counterparts. This needs to be researched and could offer an important treatment option for those patients who have suffered this devastating condition.

I will go back to Danli next year. But why go back to Honduras when there is so much poverty and so much danger? The answer is simply that they need our help. Most of the Hondurans that I met were honest hard working people. People who live to serve and give rather than take. Their poverty is out of their control. Many of them work 18-hour days to exist on a dollar a day. Many of the patients that I treated would set off at three in the morning from their mountain homes to get to the clinic where Kathy and her team work throughout the day, or to the rehabilitation centre in Danli where Anselmo and his team perform their miracles. I am frequently touched by the faith that these patients have in us volunteers. One patient who had suffered trigeminal neuralgia for 20 years followed me from one town to another as my acupuncture has given her the only relief she has ever experienced. It would be great to take another Physiotherapist back to Danli when I return, especially someone who has experience of growth problems in children and the treatment of these conditions. This is an area in which I have little experience, and the team in Danli would welcome some professional help. The local community would greatly benefit from back awareness classes, or a stroke club, or a yoga class run on a regular basis, and needs volunteers to get these projects up and running. So much needs to be done for these people. Unfortunately, they cannot afford the money to start these projects themselves and volunteers are their only hope. Most Hondurans do not have the comforts that we have in our country. They do not have the medical facilities or the benefits that we take for granted.

Most of the poor in Honduras are reliant on people like Kathy Rubio and Anselmo Rodriguez and his team who are a reminder to us all that there are people in the world with heart, and the time and the courage to give a helping hand.

These dedicated people don’t work to make a fortune. They work to make a difference. We must support them.

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About Richard Graham

Richard Graham is a Shiatsu therapist, Acupuncturist and Physiotherapist registered with the Health Professions Council, working in private practice and a GP practice in Suffolk. He teaches at the College of Traditional Acupuncture, Warwickshire, affiliated to Oxford Brookes University. In 2001 he joined International Medical Volunteers Overseas and worked on assignments in China, Mongolia and Indonesia. In 2004 he received personal and written commendations from His Royal Highness the Prince of Wales for his efforts in the integration of Western and Complementary Medicine. In 2005, following the Asian tsunami, he set up the charity Physiomed Overseas to provide rehabilitation therapy to the poor, the sick and the disabled overseas. Richard may be contacted via richard@natramed.freeserve.co.uk

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