Photo Above: The front steps of one patient’s home. There is standing water on the right and a large tree on the left, prohibiting placement of a railing.
This past month, 48 of my fellow second year physical therapy students and I had the humbling opportunity to travel to Granada, Nicaragua to experience the country and treat patients for 10 days. While there, we were completely immersed in the culture; we lived with a host family, ate the food native to Nicaragua, and communicated (or attempted to communicate) in a language different from our own. This journey taught me so much about life and also left me with impactful takeaways regarding disability in a third-world country: accessibility laws don’t exist, so neither does accessibility, desire for independence is culturally dependent, and the smallest of fixes can have a large impact on someone’s quality of life.
As we walked through the city of Granada it was impossible to ignore that this was not a place where accessibility is emphasized. There are no curb cuts, no ramps, the sidewalks are not wide enough to fit a wheelchair, there are obstacles to navigate everywhere; and this is just in the “Central Park” of the city. Once you reach the outskirts of Granada, the area where we treated patients, conditions are even worse. There, the roads are unpaved, there are rocks scattered everywhere, and there is standing water gathered in dips in the road after every block. One of our patients is 23 years post stroke, leaving her with limited strength in her left arm and left leg. She has reduced stability and uses a cane to navigate around her home. Due to the architecture of her front steps, however, she is unable to leave her house. This was the case with 4/6 patients we saw during our time in Granada.
This brings me to my next takeaway. When we asked patients if they would like to be able to leave the house, the answer was almost exclusively, no. We talked with all of our patients about their goals, what they liked to do, and what they wanted us to help them with. None of these house-ridden patients wished to leave their home, everything they wanted to do was inside of the home and they were perfectly content staying there. Even within the home, the patients didn’t really desire more independence as they had several family members who lived with them to help with everything. We had one patient who didn’t even want to be able to rise from her rocking chair alone because her husband was always there to help her. With these patients, we found things they liked to do around their home and worked on ways to make those activities easier.
One of the most rewarding feelings I have ever experienced is the gratefulness of the patients we spent time with in Granada. On our last day, we gave one of our patients a cane to keep as the one she owned was a foot too tall and way too heavy for her to use. Living in the area they do and the limited means that the family has, they would not have had access to a new cane if it wasn’t for us. Many of the other groups had a similar experience giving out assistive devices. One group reported a family in tears after giving them a stroller so they didn’t have to carry their daughter everywhere.
The people in Granada, Nicaragua left me with all of these new perspectives that I will carry with me throughout my career as a physical therapist.
