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Q&A: New book highlights realities and rewards of international relief work

Susan Klappa '94, an assistant professor in the Henrietta Schmoll School of Health Department of Physical Therapy, was asked to write the book following her 2010 experiences in the earthquake-ravaged Haiti. The 160-page book, Physical Therapists Not-Knowing During International Service Work: The Essence of Not-knowing, was published in November.

Working alongside health professionals from around the world, Klappa was described as "a miracle worker” for her tireless efforts and boundless spirit in helping patients heal and find hope in the wake of limb amputations and other injuries.

Here Klappa discusses the book’s objectives, which include sharing her experiences as a physical therapist engaging in international service-learning work.

Q. What does “not-knowing” refer to in the title of your book?

A. The process of becoming a physical therapist is competitive and, in Western cultures, we are used to having access to the resources we need to do the job. When that environment changes or is radically different, and you are in unfamiliar territory, suddenly, what worked for you before no longer applies — there are different ground rules. That’s the not-knowing.

Q. So, the book is based on your own personal experiences?
A. Yes, in part, the book is based on my own experiences working in the Dominican Republic, which was initially part of my doctoral dissertation work. It also relates to the experiences of physical therapists in medical aid and disaster situations in the international arena.

I interviewed 20 physical therapists for the book — clinicians, teachers/educators, administrators, researchers and consultants. These are people who have worked all over the globe. What comes out of the interviews is how not-knowing affects the physical therapist’s sense of his or her own professional identity and idealistic core values, and how it brings out a sense of one’s own limitations, as well as the need for humility.

Q. Say more about the implications of not-knowing.
A. It’s not unusual for physical therapists in international settings to experience a “deer in the headlights” moment when all their previous training and experience fails them and they have to rely on seat-of-the-pants judgment. They’re taught not to be the arrogant Westerner, but instead they’re experiencing a crisis of identity. It is the challenge of being in a different culture and trying to adapt to it.

Q. How does one get beyond not-knowing?
A. I believe it’s keeping a sense of humility and realizing that the work is done in collaboration with others — other physical therapists and volunteers from all over the world and the patients themselves. This work is about reaching out to others and not only to provide help and healing but to ask for help and healing.

Q. How did you choose physical therapy as a profession?
A. I grew up in south Minneapolis and was in a pre-med program with a major in biology. In my sophomore year, I went to the Dominican Republic as a volunteer through a program sponsored by the University of Minnesota to study marine biology. I lived in a village and taught the people there how to swim. They would risk their lives trying to catch lobsters, but were helpless in the water.

The villagers were such warm people, and their gratitude for the skill I had given them touched me. That experience changed my life. When the program ended, I stayed on as an interpreter with the Peace Corps and helped set up a clinical site to care for people who needed medical attention. When I got back to the U.S., I knew I wanted to do this kind of work.

Q. What is the attraction for you in international relief and disaster work — and the connection to physical therapy?
A. For me, being a physical therapist is not just about being in a clinic. On one level, I love working with the affected people in a community, spending time with them and solving the puzzle of why they’re not functioning the way they should be. It's not just a job; it becomes who you are. So, you become involved in the community, in treating others’ physical ailments — but also in advocating for fundamental changes in how society operates to take care of the marginalized and less fortunate.

Q. You were in Haiti recently and right after the earthquake last year. What were those experiences like?
A. I’ve had three tours of duty in Haiti. The earthquake occurred on January 12, 2010, and I went down there for the first time on February 1 as part of the International Medical Alliance. We landed on the Dominican Republic side of the border and set up a Mobile Army Surgical Hospital (MASH) unit that could hold up to 450 patients.

We worked with people who had been pulled out of the rubble, and we did splinting and treated for radial nerve damage. We dressed wounds with honey to keep them from getting infected; we treated people of all ages, who had to have amputations. Educating patients and their families and friends in how to care for their amputated limbs and how to use a prosthesis was a critical part of the care.

I stayed 15 days before going back to Port Au Prince in July, where I had a chance to reunite with patients and friends. We focused on teaching amputees that there is life after amputation. In the West, people learn to cope with amputation and the use of artificial limbs, but in Haiti, a person faced with the choice of amputation or death would choose death. I made my third trip this past October, sponsored by Physicians for Peace, because the prosthetic clinic at Albert Schweitzer Hospital in Deschapelle needed a physical therapist to fit patients with limbs.

Q. Were you also in Haiti during the time of the cholera outbreak?
A. Yes. We had just about finished our time there when people began coming into the clinic with symptoms of cholera. Cholera is perfectly treatable within 24 to 48 hours, but people would wait until they could barely walk before they sought treatment; some of them looked like shells of human beings.

We were taking in about 150 people a day, setting up IV solutions for them and trying to get them re-hydrated. We were doing a lot of education with the patients and their families about how cholera spreads and how to prevent re-infection. We focused on tending to those patients who had no family or friends to care for them while they were at the clinic.

Q. Have your students gotten involved in some of these trips to Haiti?
A. Because of the nature of the situation in Haiti, international aid and assistance groups were looking for fully trained and qualified physical therapists. However, I do take students down to the Dominican Republic in May to work at the clinics and in the communities there.

Q. What do you gain from the international relief work that you do, and why would you recommend it to your students?
A. I think we get to see another side of humanity. In the West, we talk about privilege and the guilt we experience because of privilege. But being privileged is not about guilt, it’s about how you spend that privilege that matters. In international relief work, we are engaging and teaching people who have no resources or the usual supports that we are accustomed to in the United States.

Ultimately, it’s about empowering people to help themselves and to allow them to carry on long after we’ve gone. As horrible as as an earthquake or disaster can be, being involved in relief work allows you to be part of something good in the aftermath.

Jan. 5, 2011 by Arline Datu

See also: Faculty, Leadership, Social Justice