This Is Why At the Extremes When determination meets need. By Jennifer Everhart, PT, MPT | September 2010 Podcast: Listen to 'This Is Why' My physical therapy career has taken me to countries on which the United Nation has bestowed such dubious superlatives as "Most Corrupt," "Worst Place for a Child to Be Born," and (currently), "Least Developed." My unconventional career path has been richly rewarding, but there are days when I ask myself, "Why am I still here?" Today is one of them. There has been a power blackout for 24 hours. Water stopped running 12 hours ago. At 120 degrees, Niamey, Niger, at this moment is the hottest place on the African continent. Throughout the city, people are succumbing to heat and dehydration. Eighteen children and their caregivers are under my care at the rehab facility I started 3 years ago. Some of the children recently had surgery and have limited mobility. There is no way to keep them cool and hydrated without water. Not far from the clinic, I find a community faucet that still has running water. I jockey for position amongst donkey carts filled with yellow jerry cans, attracting more than a few curious glances, something to which I've not yet become fully acclimated even after 9 years in Africa. Nor have I quite come to terms with the constant challenges of providing health care and rehabilitation in countries where preventable disabilities occur due to poverty and ignorance, deciding who to serve requires heart-wrenching decisions, and medical care is substandard. These challenges, combined with the extreme physical conditions, make me wonder-especially on days like today-"How, exactly, did I get here?" and "Why have I stayed for nearly a decade?" The "how," in truth, is easy. In 1994, I was straight out of college, and the Peace Corps seemed a good way to experience another culture, gain insight into my future, and do some good. Then, in Cote d'Ivoire (Ivory Coast), I met Aisha. She was 15 years old and had been diagnosed with "traditional illness," a condition the local people believe is caused by witchcraft. Aisha typically sat in solitude under a mango tree. One day as I approached her family's house, I saw two people guiding her across the courtyard. Until that moment I hadn't realized she could walk. I suggested that, with exercise, she might walk by herself. Her reaction will stay with me forever. She first asked, "I can?" and immediately replied, "I can!" All she had needed was encouragement and hope. Three months later, Aisha was walking with crutches. Four years later, I enrolled in graduate school to become a physical therapist (PT). While I've had no shortage of gratifying experiences during my years in Africa, my reasons for remaining here evolved over time. I came to cherish the privilege of working alongside and mentoring African colleagues who advocate tirelessly for the rights of people with disabilities. The PT who will replace me in Niamey when I return to the United States later this year faced tremendous obstacles when he began his career, yet he remains committed to excellence in patient care. The future of physical therapy in Africa lies in the hands of motivated, intelligent young people such as him. Back at my rehab facility, I distribute water among the patients. These include Fatima, who is 11 years old and has cerebral palsy. Despite good muscle tone and motor control, she has crawled her entire life. After serial casting, orthotics, and gait training, she's almost ready to return home with restored dignity and a new view on life. Another patient to whom I give water is Abdul, a 4-month-old with club feet. Often, club feet are left untreated, leading to fixed deformities. During a taxi ride, however, Abdul's mother had shared her concerns with other passengers, one of whom was a former patient who referred her to our clinic. We now are in the fifth week of serial casting. After treating Abdul, we will provide follow up to prevent recurrence. Today, I am beyond hot, and completely exhausted. Why am I still here? The answers are never very far away. Right now they're literally within sight.