March 2017 – Developments in the Clinic & Family

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This March finds us in a new clinic partnership, where Nick is keen on supporting recent advances in physical therapy education as they roll into patient care practices in the clinic.

Thank you for your prayers for a clinical partnership ripe for implementing change. Working with Denise and Pamela has been super encouraging thus far! These therapists opened their own clinic 2 years ago, after struggling for the freedom to provide patient care at the quality they wished. If you can believe it, they’ve gone up until this December without paychecks (living with parents, etc.), trying to get it off the ground. It is one of only a few therapist-owned clinics in our city.

Now they are able to give 1:1 patient care, whereas at some clinics, therapists might regularly juggle 2-4 patients at once!  After some time working on PT development, we can see how attending multiple patients at once not only contributes to poor patient care, but doesn’t allow the therapist to improve in the clinical skills that the community needs. At their own clinic, Denise and Pamela have been able to initiate therapy evaluations- where they can contribute their clinical judgement on a patient’s care, vs follow often generalized and non-specific protocols from referral sources.

140e77e7-0547-4f74-98b8-bac46625e4deSince Nick started collaborating last month, the therapists began daily treatment notes. Any health care provider reading this knows how tedious documentation is- but imagine not writing down what you did with a patient during the visit, and how that would affect your ability to progress their care, or track if what you were doing was working. They’ve also spent time learning functional outcome measures and orthopedic special tests, which help distinguish the source of orthopedic related pain. Therapists here learn a small amount of evaluation skills in school. But for a variety of complex reasons, few are actually able to develop the skill of forming a professional opinion on a patient’s condition, let alone share it with the health care team, or act upon their judgement in the clinic. Patients’ health suffers for it. Pray that this slow process of learning clinical reasoning skills would really blossom in Denise and Pamela. Their dedication to extra reading and ability to demonstrate new knowledge during patient care has thus far been outstanding! Both therapists are the newest adjunct faculty in the PT department here, so we’re hopeful that supporting them will translate into much more than even their own patients’ improvements.

Inner Workings of Development
As our ministry partners, reflect with us for a moment about how we engaged in this new ministry move– What does it mean that we try our best to follow development principles in our work? Right now, it looks like Nick offering to provide consultation to this clinic for a nominal fee of  ~$125 for a month of individualized training and recommendations. We hoped this would ensure that the therapists were interested and engaged in the teaching, since they have a clear financial stake in it. We actually started out requesting ~$210 for the month- a good deal for a Dominican therapist’s time. After hearing of the financial hardship of the clinic, we reduced the price and bartered a requirement for the therapists to provide a continuing education course on what they learned to their colleagues. This turned out to be a better plan than just payment! The discussion also allowed for conversation around the concept that we are here in the country as missionaries, under the reality that God calls us to love our neighbor with our time and money, not just make as much as we can for ourselves.

Finally, Nick pitched the idea with a “consultation services” agreement, giving them a variety of training options they could alter and choose from, further allowing therapists to own and engage in the process. This particular clinic represents a miraculous combination of therapist willingness and a setting where the therapists themselves have the administrative ability to make the changes they wish to see. We’re not sure if this model could be as successful in another clinic, bogged down by administrative restrictions. Thanks be to God for this opportunity!

God’s Provision
Once again, God has provided through you for another year of ministry in the DR. Thank you so very much to the many faithful and several new financial partners in this work. You are a great blessing to us as you pray and support, allowing us to lean into what God has for us to do here in the DR. Thank you, thank you, for your love and sacrifice.

Family Notes
This last month has been an icky one with illness and sleep. Mateo had his first fever. This would have probably been an urgent care or weekend office hours visit in the US, but, none of those are available here, and protocols for some of the mosquito borne illnesses require blood work with a timing that entailed a Saturday ER visit. The only lingering effect has been a return to sleep patterns of waking every 1-2 hours at night… Ooff! Following this, a few of us were hit by a vomiting bug last week. Please pray for health for our family. We could definitely use some more sleep, personal and marriage time- if that is a thing anywhere in the world for parents of young children:). We are focusing on the discipline of gratitude to get us through!

Mateo is sitting and furniture standing now at 7 months, with tons of smiles, except for the camera. Laurie turns 36, Daniel 3, and our marriage turned 8 within a month’s time! It has been great fun to listen to Daniel’s Spanish take off, and less than great fun learning to take turns with toys:). We recently enjoyed a fantastic day on Mateo’s first (and successful) trip to the beach.

We continue to pray for you as well as our US country of origin. May God give us wisdom and strength to engage with our neighbors in love, wherever we find ourselves in the world. Sending our love- Happy March to you!

Nick, Laurie, Daniel & Mateo

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