Defining Moment A Mission in More Ways Than One A question is answered in Central America. By Ryan Borck, PT, DPT | October 2014 Listen to 'Defining Moment' I fidgeted uncomfortably in the cold metal seat as nervous sweat seeped into my suit coat. Sitting there, I tried desperately to evade their intent eyes. But the box-shaped interview room, bland as the interior of a cardboard box, offered few distractions. They were awaiting my response. I paused. Swallowed. Took a deep breath. The question I was about to answer might be the most important one of my life. That hot seat culminated years of effort. Countless prerequisite lists, advisor visits, vocabulary study sessions for the GRE, and summer classes had landed me the big kahuna: an interview with my top choice for physical therapy school. All my preparation led to the query posed by my program director and the head of neurology. It dug to the heart of who I had been, was, and would become. "Why do you want to be a PT?" Flash forward: the present day. I'm in Guatemala. It's 2014. This time I'm sweating because of the equatorial climate. It's my second trip here in 20 months. The rural province of Zacapa is a mountainous region in a state of flux, with Toyota dealerships blooming like cane trees from empty fields and signs of rapid infrastructure development. Frequent military convoys signal a governmental crackdown on drug trafficking across the nearby Honduran border. Look deeper, though, and a different picture emerges. Guatemalans subsist in dirt-floored huts with no plumbing. There is no consistent health care or education system. The roadways betray gross economic disparities, as Audis mingle with overloaded mopeds that carry as many as 4 or 5 adults, infants, and/or pets. Guatemala has entered the 21st century yet remains very much a work in progress. My presence here is a physical manifestation of my answer to the question I'd been asked 5 years earlier. I'd told my interviewers that I wanted to serve others and make a difference in the world, but that, at that point, I lacked the knowledge and skills to do so in a meaningful way. Physical therapy school, I said, was the means to my goal. And my decision to concentrate on orthopedics was a practical choice to do the most good for the most people. Who, after all, doesn't know someone beset by back pain, bad knees, or unstable joints? The people of Guatemala have much in common with Americans as far as that goes. In 5 days on this trip, our clinical team has completed more than 100 evaluations for conditions ranging from low back pain to cerebral palsy. We are all United States-based therapists, supported by ATI MissionWorks. That's an initiative of my employer, ATI Physical Therapy, which provides orthopedic rehabilitation services to children and families in developing countries. In a single day I evaluate 8 individuals for spine pain. The personal stories, however, are far more powerful than is any aggregate number. Juan hops into the clinic wearing a big smile, trailed by his concerned mother and grandmother. The 12-year-old fractured his tibia and fibula last year when the moped on which his entire family was precariously balanced collided with an automobile. Emergency surgery resected the fibula and fixated the fracture, but in the absence of further treatment his ankle accumulated massive scar tissue, with consequent range-of-motion (ROM) loss and equinovarus contracture. Juan has been carrying his crutches more than he's been using them. He toe-walks, weight-loading his lateral forefoot and hopping to get around. We instruct his family in cross-friction mobilization and targeted stretching, to help get his feet flat to the ground so he can walk normally. Juan hasn't lost his irrepressible spirit. "What is your goal?" I ask. His response is immediate: "To play!" With dedication to his exercises, his odds of restored function and fun are excellent. Glaybe is a 40-year-old truck driver who has been idled for months by injury. His first question is, "When can I go back to work?" He, like Juan and countless other Guatemalans, incurred trauma from an accident on the country's peligroso—dangerous—streets. Seven months earlier, a tibial fracture required surgical fixation. Despite radiograph imaging indicating good healing, he has been unwilling to place more than about 10% of his body weight on his leg—fearful that applying more pressure will cause his leg to snap like bamboo. The result has been major loss of ROM in his knee. We lead Glaybe through progressive weight-acceptance activities to stimulate bone remodeling and desensitize weight bearing. We help him stretch his leg. He leaves the clinic that day with his confidence restored and his life reclaimed. Soon, he literally will be back in the driver's seat. Every day brings new stories. One frail gentlemen fell down a mountain while harvesting crops, snapping his fused hip and leaving his leg dangling on soft tissue. A woman shocks us with a confluence of 5 comorbid lower-extremity conditions. At times, the amount of work awaiting us, relative to our numbers and time, seems overwhelming. On the other hand, we revel in the hunger for learning and sharp intellect of the local physical therapy students we instruct. Their minds flash like strobe lights, absorbing everything we teach. We know we are leaving a lasting mark on this community. As the mission trip ends, I'm reminded of the story of the man who happens upon millions of beached starfish left to die by the receding ocean tide. Rather than despairing at the hopelessness of their collective plight, he stoops, lifts a single starfish, and throw it back into the water, knowing that his effort mattered to that one living organism. "That one" is the reason I am a PT. Ryan Borck, PT, DPT, is employed by ATI Physical Therapy in the western suburbs of Chicago.