AASPT Traveling Fellowship

Fellows @ Cincinnati Football

Long before sunrise on the morning of Thursday, September 12, 2019, I boarded a sleepy airplane lightly coated in the typical Pacific Northwest mist heading towards a career-enhancing expedition.  After a brief pit stop in Denver, I continued on to Cincinnati airport, weirdly located across the Ohio River in Northern Kentucky.  Upon arrival at the CVG baggage claim I met two physical therapists who I would spend the next eleven days learning and observing various topics related to sports physical therapy. Rebecca Troulliet from North Oaks Health System in Louisiana and Patrick Barber from University of Rochester in New York joined me for the American Academy of Sports Physical Therapy (AASPT, formerly known as the Sports Section) Traveling Fellowship.  Sponsored by Kevin Wilk, LightForce and DJO Global/DonJoy. We spent about three days each at University of Cincinnati, Mayo Clinic locations in Minneapolis and Rochester, Minnesota, and The Ohio State University. 

What does it mean to be a Fellow?  According to Wikipedia, "a fellowship is a group of people who work together to pursue mutual knowledge or practice."  Though each of us had individual purposes for participation, we are all physical therapists working with athletes and we were all looking for growth in our careers.  Through observation and lecture attendance with more seasoned clinicians, we had exposure to different techniques and clinical approaches than our usual day-to-day experiences.  Now that I've returned to my usual swing of things and seeing my patients at Seattle Children's Hospital, I'm taking this opportunity to reflect on the experience and share why I chose to pursue this Fellowship along with some highlights from our trip. 

First: Why did I want to complete a Fellowship?
In May 2014, when I was completing PT School at the University of Connecticut, my career aspirations were to serve as a team physical therapist in the WNBA.  I had previously worked in a non-medical capacity for the Connecticut Sun for four seasons, but elevating to this new type of position as a new grad PT didn't seem remotely feasible.  Beyond the fact that I was a new clinician,  WNBA teams didn't have physical therapists, then, so this goal seemed unrealistic. (Most teams still don't, which I wrote about here)  I thought my fastest route to working with professional female athletes was to advance my education from PT School through a Sports PT Residency Program. In 2014 there were about twenty of those programs nation-wide, mostly offering one or two slots. I applied to three, including Ohio State, but was not successful in securing a position.  Now there are almost fifty SCS Residency programs with so many more opportunities nationwide! To search Residency programs in any PT Specialty area, click here.

Fortunately, physical therapists have an alternative route to obtaining board certification and specialization in sports physical therapy that does not require participation in a residency program.  You can find the requirements to do so here. As I pursued the alternative route, I also landed a role with the Seattle Storm, and in March 2019 completed my Board Certification Exam.  In our cohort, Pat also took his exam in March following completion of the University of Rochester Residency program and Becca is currently working through the alternative route requirements to specialize in the future.  So because I did not complete a residency program but did pursue specialization, I felt like I lacked some of the mentorship and on-field hours that a residency would have provided, and this fellowship filled some of that gap.  

Second: What was the Fellowship like? 
Each location was very different from the others which helped us gain a broad spectrum of the possible roles and responsibilities for a sports physical therapist.  

Fellows and PT staff @Cincinnati

At the University of Cincinnati, we were hosted by Bob Mangine and Tim Machan and primarily spent our time in their athletic training room with them and on the sideline.  We had the chance to watch game-time coverage, led by Head Athletic Trainer Aaron Himmler and had a sit-down discussion with their concussion program and vision training expert, neuroscientist Dr. Joe Clark. We attended lectures on a variety of topics by members of their staff including wearable technology, use of the ACL-Return to Sport Index Outcome Measure, Neuroplasticity, Prevention of Catastrophic Injuries, and and we each presented our own lectures. My presentation examined the Impact of Fear Avoidance on Return to Sport, Becca discussed Sudden Cardiac Death and Pat outlined Upper Extremity Return to Sport Tests.  

With Timberwolves Robby Sikka and Matt Duhamel

After exploring Cincinnati, the three of us packed our bags to head to Minneapolis for the first half of our visit to the Mayo Clinic.  Our host in Minnesota was Corey Kunzer who is the coordinator of the Mayo Residency program.  The clinic in Minneapolis serves the community as well as having partnerships with the Minnesota Lynx (WNBA), Minnesota Timberwolves (NBA),  and Minnesota Twins (MLB).  Only days before our arrival, the Seattle Storm had knocked the Lynx out of the WNBA playoffs so I felt a little like I was in enemy territory, but I was glad to finally meet Emily Beyer, Lynx Team Physical Therapist as well as Matt Duhamel, Team Physical Therapist/Director of Athletic Therapy for the Timberwolves and Jeff Lahti, PT for the Twins.  We also met Robby Sikka, Timberwolves VP of Basketball Performance and Technology who uses wearable technology with the basketball players to improve their on-court performance.  Their basketball facilities are fantastic and, according to their staff is considered to be the best training site in the NBA. They have practice basketball courts with athletic training rooms and locker rooms for the teams right next to the medical clinics where they have physical therapists, orthopedic surgeons, physicians, athletic trainers, and other specialties who can thoroughly care for the athletes alongside the general public.  Can you imagine being at your PT session and rehabbing alongside (Lynx superstar) Sylvia Fowles or  (Timberwolf and UConn great) Shabazz Napier?! The Mayo providers collaborate with the team providers in their biomechanics lab which includes force plates and multiple angles of cameras for jump-testing and movement assessment as well as for recommendations for optimal care.  It was a really interesting arrangement for sports medicine for all levels of athlete.

Diagnostic Imaging with Dr. Jay Smith @ Mayo

Then we drove down to Rochester, MN, home of the original Mayo Clinic.  Founded in 1889, the Mayo Clinic is basically the entire town of Rochester and the area is spotted with old historical buildings that contain the most beautiful old libraries and intricate marble ceilings that tell the history of medicine in the US along with more contemporary constructions housing the huge variety of specialties that the Mayo Clinic houses.   We learned about Diagnostic Ultrasound from expert Dr. Jay Smith were taken to the Mayo Clinic Biomechanics lab which houses the machine used by Dr. Tim Hewett to extensively study ACL injury, and participated in a golf biomechanics lab.

Coach Tamika (Williams) Jeter @ OSU

After Minnesota we headed to Columbus, Ohio, home of The Ohio State University Buckeyes.  Our host, John Dewitt took us on a tour of their athletics and training facilities where I ran into former UConn and Connecticut Sun basketball player Tamika Williams for a quick reunion.  We attended a discussion on articular cartilage surgical procedures presented by Caroline Brunst and a lecture presented by Dr. Ken Yeager on Building Resiliency observed the nationally recognized Ohio State Marching Band rehearse, attended the marching band Skull Session pep rally and another football game.  We had the chance to meet many of the Ohio State Physical Therapy Residents studying in a wide variety of specialties including performing arts, oncology, sports, orthopedics, women's health, and neurology.  And I got to see some of my Ohio family living nearby, which was the cherry on top of a really awesome collection of learning experiences.

Fellows with John DeWitt @The Ohio State University

I can't recommend this Fellowship highly enough, and would be happy to connect with anyone considering application for future participation.  I'm sure that if you asked Pat and Becca, they would select different portions of our trip as their highlights or what was most impactful based on the differences between our patient populations and professional goals, but I'm so glad I was able to share this impactful experience with them.  Thank you so much, American Academy of Sports Physical Therapy for this opportunity!

Volunteering in Tanzania

Africa was never really on my bucket list. It's SO far away from Seattle and pretty expensive and I didn't see the point in taking so much vacation time to go somewhere that is portrayed the way Africa often is.  And on top of that, why would I take a vacation to work somewhere else for free?  I thought I was going to a very poor place, a desert that would have been all brown, ugly, and dirty, with people who I knew nothing about whose circumstances don't impact my life. I've heard that safaris were amazing, but I despise zoos because they make me sad for the animals and I thought that a safari would feel the same way.  So what reason would I have to put this on my bucket list?

Me and Kristen

A year ago, I met Kristen, my coworker at Seattle Children's Hospital and an East Coast transplant who says Florida like every other New Yorker ("Flaahhrida") and won't eat at a pizza restaurant that doesn't sell by the slice because that isn't the true New York way.  She exudes an incredible passion for life and is a really talented physical therapist.  And she LOVES Tanzania.  LOVES.  She invited me - and several of our coworkers- to go along with her as she supervised a group of PT students from her alma mater, Stony Brook University.  So with the above reasons I had identified not to go, among several others, one key reason on my "yes" list ultimately won: I realized that I wanted to.  It hadn't been on my bucket list because people weren't talking about it, because it's not a top travel destination, because I don't know anyone from Tanzania or even anyone who had ever visited. But I wanted to travel to a new place. I wanted to meet new people, experience new cultures and eat new foods.  I wanted to see an elephant and a giraffe and a zebra in the wild and see that it wasn't like the zoo.  I wanted to connect with my coworker outside our office - because we had already started to become friends - and what better way to really explore a new friendship than spending every minute together for two weeks?  I wanted to give my time to people who needed it more than those I usually give it to.  And I wanted to confirm or dispute all of my preconceived notions.

Mt. Meru

I learned that in many cases I was wrong.  I wasn't in the desert at all.  In fact, Tanzania doesn't have desert.  The Sahara doesn't cover the entire continent of Africa.  Yeesh...There were tons of sunflowers and trees and our hotel had this AWESOME view of Mt. Meru easily visible in the afternoons when the clouds had dissipated.  It even rained despite being the dry season.  The safari animals are truly free.  Lions out in the wild are breathtaking.  There are birds with so many bright colors, they gave Costa Rican parrots and exotic rain forest ornithological creatures a run for their money.  They cooked foods with curry and I didn't really have to eat that much rice, which was good, because I don't really like rice, but for some reason expected to be eating it all the time.  

In some cases I was also right.  I was eaten alive by mosquitoes despite bathing in bug spray and sunscreen.  If you've seen any of my Facebook posts where I'm wearing a bandana or a headband - those weren't for fashion.  They were bathed in permethrin in an effort to reduce my bug bites.  I think it helped - my face didn't suffer nearly as much as my arms and legs did.

Traveling Pharmacy

Our group collectively did need most of the pharmacy that I brought with me.  I exclusively consumed bottled water including for brushing my teeth, but many meals did not agree with  my digestive tract. I got a nasty cut on my finger that required first aid care. Others in my group experienced some illnesses. Plus, the anaphylactic reaction I wrote about here.  

Our work and the things we saw were emotionally intense and left my mind wandering into the wee hours of the night, limiting how much sleep I was getting. (I would never blame late night chats with Kristen for the lack of sleep... ) I over-estimated what was available to the people of Tanzania, and as such, was a bit shocked by what I saw and what I learned.  Now I've been back home for just over two weeks and I'm still processing the experience. When it came up in conversation today at work, a wave of emotions flushed over me, just as it did while I was there.  The number of times "how was your trip" gets asked declines exponentially, but the feeling hasn't changed yet. 

Sandals made from recycled rubber tires

I've really been struggling to write and talk about my experience volunteering in Tanzania.  As much as I have tried to explain it, my words and photos are insufficient.  It's far easier to talk about the animals on safari and pretend like the volunteer work never even happened.  The zebras don't really elicit my emotions.  But talking about my volunteer work sometimes comes out as if I saw a world of poverty, despair, and sadness.  This was not the case.  

The people I met in Tanzania were a wonderful community who prioritize hospitality, traditions, family, and kindness and who happen to live in a place that simply has less.  Less of pretty much everything.  Less material "stuff" available to them than where I come from. Like shoes - where multiple times I saw these sandals made from recycled car tires.  Less money (Tanzania has .03% of the world's wealth averaging $2716 per adult - 2nd from the bottom of this list - compared to the US which has 25% of the world's wealth and $201,319 per adult - 3rd from the top - and consider that we have 607 billionaires in America according to this article averaged in along with the Americans living beneath the poverty line).  Less opportunity.  Less healthcare (269 hospitals in the country for 50 million people over 365,000 square miles (5.38 hospitals per million people) compared to the US 6200 hospitals for a population around 320 million spanning 3.7 million square miles (19.375 hospitals per million people) which just means both countries have areas where people have to travel far for a hospital, but in Tanzania, there are many more people trying to use less facilities.  Shorter life expectancy: 61.8 years compared to the US 79 years. Less schooling for children with disabilities - we learned about every single school for children with disabilities and how many students they accommodate and how many teachers they had in less than 45 minutes.  For all of Tanzania. Less infrastructure.  Less electricity.  Less drinkable water.  Less education (27 universities and 15 colleges versus 4298 higher education institutions in the United States.

Shanga Employee Wheelchair

So they have less... but does that make it bad?  No. And in some cases, cases that really matter, they also have so much more.  They have more family time.  Families live in close proximity with one another and honor their past traditions as they try to be a little bit current while simultaneously adhering to their tribal laws.  They have more respect for their elders - in fact they even have a specific greeting intended to be used with elders rather than for peers. They have more kindness.  They have more generosity.  They have more sharing.  I'm pretty sure they have more work ethic than many of us, working in more labor intensive work than many of us face.  They have more connection to their land and to their animals and to their religion.  They have more healthful food that does not contain the chemicals and processing we add to ours. They have more national holidays.  They have better maternity leave (12 weeks fully paid). They have the same sun, moon, and stars in the sky, but less pollution obstructing your view to see them.  They have the benefit of waking daily to the crow of the rooster, rather than those annoying ring tones installed by Apple set to go off every 9 minutes.  I really started to like waking up to the roosters.

Despite what you may have heard, there may be one planet Earth, but the world is not the same everywhere.  Tanzania is nothing like the United States.  But that does not make the United States better.  It just makes us different.  And, at the end of the day, we're all human beings who bleed red and breathe the same air.

Glass beads made at Shanga

The group of volunteers I went with were four Physical Therapy students from Stony Brook, one of their professors, Kristen, and myself.  Seven Americans split between two facilities volunteering in Tanzania.  One of the facilities was a school for children with disabilities called Step by Step where Kristen supervised two students.  My team was at Shanga which is basically a workshop and store that makes and sells crafts from recycled products and employs people with physical disabilities.  Shanga provides employment and salaries to individuals who would otherwise have much more difficulty finding work  Through sale of their products, visitor donations, and their larger parent company, they can feed their families and have support with access to medical care and equipment.

George teaches group exercise class

At Shanga, we assessed the needs of the employees.  A year before us, they had been visited by Stony Brook students who had developed an exercise program that the staff would participate in about twice per week.  They embraced their new program last year and were eager for some upgrades.  The previous program had some limitations such as a key focus on mobility, but not very much on strength.  We were able to update the program and we taught the leadership team basic concepts of exercise and ways to modify the program to try to give them more ownership and ability to have variety.

We also did one-on-one evaluations of several employees experiencing pain or with mobility issues they were hoping to improve.  There were some employees who had amputations who needed assessments of their prosthetic limbs, something I never do at Seattle Children's but had done on my clinical affiliation in New Mexico during PT school.  Other employees had experienced injury or been having some health issues they wanted checked out like cardiac concerns.  Some had seen last year's PTs and wanted an updated program, as well.

And so, I've described my volunteering experience.  But really, I've tried to explain that the way we view the world from here is through a distorted lens.  I, too, am guilty of this.  It isn't gone now, I'm just a little more aware, now.  Our pre-occupation with money and objects in the United States may be holding us back from some of the other beautiful values seen around the world.  I pray that this experience helps me reflect on what is truly important and embrace those things more in the future.