“Teach a Woman to Fish. . .” Mentoring Peru’s PT Pioneers Toward Self-Sufficiency

Mission trips that deliver modern healthcare services to children with disabilities in underdeveloped countries are admirable. Founding a permanent clinic in such a country– and guiding its evolution toward independence in serving the needs of those children– is even better.

Pennsylvania physical therapist Jodee Fortner accompanied Medical Ministry International (MMI) on a short-term mission trip to Peru in 2005, moved to Peru in 2010—and stayed for seven years, establishing a permanent physical therapy clinic for children with disabilities and training and hiring Peruvian citizens to perform the essential therapeutic exercises so necessary to the children’s improved mobility. MMI-Peru continues to care for the poor in need of medical care through their short-term mission projects welcoming medical professionals from North America as well as daily through their permanent clinics including rehab, dentistry, optometry, and psychology.

Lawall P&O initially provided donated orthotic braces to support their efforts. Lori Greenawalt, who has been volunteering with MMI since 2004, remembers those days well: “The donated braces had been used or left over, or were ones that people didn’t pick up—and although we do our best to make them fit with padding or other adjustments, this wasn’t ideal.”

Fortner and her successors at the Arequipa clinic also took casts of her more complex patients. They had the casts delivered to the U.S. for Dave Lawall and Lawall P&O’s Bill Smith, who then custom-created more appropriate orthoses to take back to Peru. But more help was needed.

“We had so many patients, and most were in braces, and the kids keep growing–! So we knew it was time to start making braces in-country—in Peru,” said Greenawalt. “I’m an accountant by trade, but I’m not afraid to ask knowledgeable people to help because I believe in this cause.”

So she consulted with Lawall’s experts on building and equipping an orthotic lab in a country where none had existed before.

Pat Lennon, Technician, not only led her on an educational walk-through of his lab at Lawall P&O, videotaping their manufacturing process for reference, but he also quickly bought into what Greenawalt calls “the big dream,” guiding her in identifying which pieces of equipment were most essential to an orthotic lab and where to buy them on the internet.

“He didn’t just give me a tour; he stayed connected throughout the year it took before we got all those essential things in-country and the Peruvian clinic began making braces under the supervision of locally-educated Physical Therapist Manuela Valdivia Tuesta – PT, C/NDT, Director of the MMI-Peru Rehab Clinic.” Greenawalt reports. “Since the day I met Pat, each time I’ve been in Peru (generally three trips/year), I have made WhatsApp calls with Pat so he could offer guidance as he watched her make them and offer useful tips.”

Lennon reflects that although he creates orthotics every day, it’s incredibly fulfilling to provide them for less fortunate people who can’t afford braces—especially when they’re in a foreign country where resources are scarce.

He was attracted to the project by the challenge of building something that hadn’t existed before in such a remote location. “They were looking into the tech aspect of it rather than a practitioner aspect,” he recalls. “Although we’re still making a few orthotics for MMI, we’re also focused on helping them to build their process of making their own AFOs (ankle-foot-orthoses)—providing some materials, showing them the different types of machines that would be useful for them to use down in Peru.

When they finally got their space, they had me on a Zoom call, and we were walking around in the lab space, trying to decide the best place for each machine they acquired. It was pretty cool!”

As the Arequipa clinic’s ambitions grew—to learn to do more for more children and families—the nature of Lawall’s support also evolved, from donors and device-makers to consultants, mentors, and friends whose support often takes the form of insights and advice. Greenawalt gratefully acknowledges a list of other generous donors but points out that “Lawall is helping but in a totally different space unconnected to donated equipment and devices. I call Pat or Bill or Dave when I need something and just say, ‘How would I go about whatever–?’ And they just help me navigate. They’ve been fantastic.

“They helped us figure out that we could get started, and they let us shadow them in their workspace to understand the process. They’ve been available on the phone, made us braces if we bring upcasts, and bought items like swash (a hip brace) and foam, which we can’t get in the country. They have been just really, sweetly helpful in so many ways!”

Only some realize that in a country with rare resources, pioneering efforts require flexibility, creativity, and economical solutions from those spearheading progress.

“Lawall recognized that, and we’re grateful,” says Greenawalt. As a result, in part, of their evolving collaboration, Greenawalt has terrific success stories to share—of cases where the therapists’ concentrated neurodevelopmental-based therapy awakened unused muscles in children whose disability had previously prevented them from walking—and the joy of demonstrating to parents that with appropriate braces and continued treatment, their child can indeed be actively ambulatory.

One small boy required back surgery because of a disabling fall; doctors told his parents he would always be an invalid. Yet a month after daily intensive therapy at the MMI clinic, appropriate wrapping and braces, a walker, and some assistance, he was walking outdoors, with future potential to be discovered.

Dominic, a child born with arthrogryposis – a disease causing significant joint deformities in his arms, hands, and legs–has been a patient of MMI since birth. Over the last ten years, Lawall has made specialized braces that allowed him to ambulate from an early age despite the significant deformities. Dominic who had befriended Greenawalt during her previous stays at the Arequipa clinic, was eager to greet her when she arrived for her visit last spring. He still walks with difficulty following leg operations, yet he runs laboriously to welcome her. “Tears were streaming down my cheeks because he was running!” she remembers. “Today Dominic is a beautiful young man fully engaged in life! This would have been impossible without the annual braces from Lawall, which helped Dominic engage in life, work his muscles, and participate with other children from the time he was a baby. This enhanced his surgical outcomes once funds were raised for the multiple surgeries he had received.

“These therapists do wonderful work, and eight out of ten of these kids have a brace or an insert on during therapy—and now, with Lawall’s help, we’re able to make those needed braces for them as well!” she notes gratefully.

“The work being done in the Rehab Clinic in Peru takes the engagement of support of so many as funding for and access to equipment is limited. What makes Lawall special is that they engaged over 10 years ago and have walked beside us for the years since, helping us to improve our skilled care for the littles who are brought through our clinic doors, we find in orphanages or living on the street often with a single parent or grandparent. I’m an accountant. I cannot offer any support in this space that helps change a life, but Lawall does and was willing to engage with me and dig in deep to support our efforts to service the poor and disabled in the southern highlands of Peru.”