Miracle workers

Imagine yourself walking into a fitness center filled with exercise machines like stationary bikes, treadmills, barbells. You look at the people exercising and you realize many of them are moving like they were in a slow-motion film. Many of them are white-haired, while others are on crutches or have an arm or leg in a cast.

These are scenes that unfold every day in our larger hospitals, in the rehabilitation sections. Instead of gym instructors, there are physical and occupational therapists working with patients with all kinds of disabilities.

I thought about all this while writing my speech for the graduating class at UP’s College of Allied Medical Professions (CAMP), which had its recognition rites last Tuesday. Today, the class will join hundreds of other graduating students at UP Manila’s general commencement exercises. The other graduates will be from medicine, nursing, dentistry and pharmacy, as well as arts and sciences.

I’ve never liked the term “allied” because it suggests that the therapists are mere assistants carrying out doctors’ instructions. In reality, the therapists are nothing short of miracle workers: helping the deaf to hear, the mute to speak, the lame to walk…or even to dance.

The public perception of the allied medical professionals is that they “just” exercise the patients. This view underestimates the value of the exercise. Patients who may have had the best orthopedic surgeon will not be able to regain the use of their injured arm or leg without well-planned exercise.

Physical rehabilitation isn’t just for patients with fractures; in fact, many of the patients going through exercise actually have injuries in the brain and nervous system. This includes stroke survivors and patients, usually elderly ones, with dementias (e.g., Alzheimer’s).

Occupational therapy is more oriented toward helping patients “exercise” their brain. There’s also a physical component here, as patients learn to coordinate mind and body, for example, picking up beads and counting them. In many ways, occupational therapy resembles the work of early childhood education: Patients are encouraged to read, or to tell stories.

Breakthroughs

All kinds of specializations have emerged in the last few years for these professions, in response to new findings and breakthroughs in medicine. When my sister was taking occupational therapy at UP in the 1970s, and for several years after her graduation, I never heard her talk about Alzheimer’s disease. It was one of those mysterious ailments that no one, not even physicians, seemed to understand. Today, Alzheimer’s has even become a verb in Filipino. When I have a senior moment I go, “Naku, baka naa-alzheimers na ako.”

My sister went to the United States to take graduate studies in speech pathology, and today her patients range from children with stuttering problems to elderly people recovering from strokes, and even men who have had gender reassignment and need now to learn to talk like women. Today, UP CAMP offers degrees in speech pathology, audiology (the science of hearing) and a generalized master’s course in rehabilitation medicine.

Until about 20 years ago, the medical professions believed that injuries in the nervous system were permanent and irreversible. But through the years we’ve learned that the brain and the nervous system have amazing capabilities, including the ability of injured tissue to regenerate. There is tremendous “neuroplasticity,” an ability of the nervous system to adapt and to compensate.

It doesn’t end there. There’s also a field called psychoneuroimmunology with a merciful abbreviation of pni.  More than a wonderful word for Scrabble games, pni describes how our body’s ability to prevent and fight disease is so linked up to psychology and neurology.

The importance of all this integration is borne out in the work around Alzheimer’s. From my own personal experience caring for someone with Alzheimer’s, as well as reading medical journal articles and attending medical conferences on dementias, I know that the greatest beneficial impact for patients is not from the medicines but from the occupational and physical therapy.

In my speech to the graduating students at UP, I reminded them that they are miracle workers because they are faith healers. Whether in occupational or physical therapy, the main value of their work is restoring the faith of the patient, and the patient’s family, to overcome disability. I see this every time in the rehab wards, and in my close relative with Alzheimer’s who glows whenever she comes from the hospital rehab session.

The bonds between therapists and patients are so important. My relative sees her rehab therapists three times a week, so they know her much better than her neurologist, or cardiologist, or even physiatrist (a physician specializing in rehabilitation), does.

Discrimination

But perhaps the most serious challenge for Filipino physical and occupational therapists is to change hearts and minds, in the way we look at the disabled, the elderly, the special children. There is still so much discrimination against people who are “different,” and the care we give for our own elderly, the disabled and the special children tends toward being patronizing or condescending. We keep them locked up at home, immobilized, sequestered, with little mental stimulation. I’ve actually heard people opposing rehab and doubting its effects: “Kawawa naman, ang tanda-tanda na ipapa-exercise mo pa” or “Bakit, babalik ba ang kaniyang memory?”

I explain that occupational and physical therapists, by bringing about almost miraculous changes in patients, do translate into wellness and healing. I know that in my relative with Alzheimer’s, the work is just slowing down the worsening and that she will never go back to being “normal.” Still I look at the impact of occupational and physical therapy as nothing short of a miracle. There was the time when, in the rehab section, she called out to another elderly patient, “Hilda, Hilda!” Indeed, she had recognized one of her best friends, who she hadn’t seen in months.

Even in her most “fogged moments” where my relative does not recognize anyone, I find consolation and strength in the way she can hold my hand, tightly, or in how her eyes light up when she hears her grandchildren.

The undersupply of therapists in the Philippines is acute, and even as the need for their services will increase, we just are not getting enough therapists, mainly because the professions are not too glamorous, and are not known too well.

And so I write today’s column, hoping people will better appreciate these professions, and to say thank you to CAMP and other schools of “allied” medical professions for keeping up the training. I thank, too, the therapists who choose to stay and work in the Philippines, working hard each day to achieve little gains that bring such great joy to patients, friends and families.

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Email: mtan@inquirer.com.ph