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In an orphanage perched on a hill high above Quito, Ecuador, a 4-year-old boy with cerebral palsy was trapped inside himself. He was non-verbal and had never walked.
But that was about to change.
The night before, a group of Northeastern students, led by physical therapy professor Lorna Hayward, arrived at the orphanage with a load of rehab equipment that included a gait trainer, a wheeled device that helps people who can’t stand, practice walking.
“We got him to take his first steps,” recalled Marcela Donat, DPT’15. “It was an amazing moment. For him, it was pure joy. When he got the hang of it, he just took off. He wanted to go everywhere with it.”
Largely due to the progress he made in physical therapy, the boy was later adopted by an American family. It was the kind of dramatic success that highlights the value of the Alternative Spring Break that Hayward has led to Ecuadorian orphanages for the last 13 years.
The goal is to create a meaningful learning experience for both sides over the nine-day span. The trip part of a year-long capstone project that begins with an assessment of the specific needs of the two orphanages they will visit and the specific children they will work with there.
In the months leading up to the trip, students fundraise to buy equipment for the orphanages, prepare treatment plans for their patients, and plan their research projects. Once there, they work with their assigned child and help train orphanage caregivers to use the new equipment.
“The goal is to build capacity within the community, rather than just do stuff for them and leave,” said Hayward.
In recent years, Hayward has added another component—a cross-disciplinary project in which physical therapy and engineering students collaborate to design inexpensive rehab devices that will help kids in the orphanages.
In 2016, the team created an 18-inch sensory cube to help improve the mobility and concentration of 3-year-old twins who were blind and had cerebral palsy. Based on student research, the cubes dramatically improved their range of motion, attention span, and ability to follow directions
Another year, the team designed a 3D-printed device that would help non-verbal children with compromised motor skills use an iPad to communicate. Two of the iPad kids were adopted by American families.
“What helped seal the deal is that they could communicate,” said Hayward. “We’re fostering independence. Through our work, we help them get adopted quicker.”
One of the most important lessons students learn during their time in Ecuador is that effective treatment often depends on understanding another culture.
“This is especially important for physical therapists in American cities who often work with people from all over the world,” said Donat. Her first job after graduating was on the pediatric unit of Franciscan Children’s Hospital in Boston, where she worked with many families from Arab countries that have different styles of child-rearing.
Isabel Ramos-Mucci, DPT’19, said one of the biggest challenges in Ecuador is the stigma attached to people with disabilities.
“If you don’t have two working legs or two working arms, you’re seen as useless,” she said. “You don’t see disabled kids in public schools because they go to separate schools.”
Several students had trouble adjusting to the continued influence of machismo in Ecuadorian culture, particularly the assumption that the male practitioner is always right.
“Students learn that it’s hard to advocate for someone when their culture views the world differently than you do,” said Hayward. “It forces them to learn cultural competency and awareness. This is why the Ecuador trip is so important. You can’t teach advocacy and social responsibility unless you’re doing it.”
The Ecuador experience affects students well beyond its nine-day duration.
Within months of his return from Ecuador, Josh Avery, DPT’11, held a fundraiser at a pub popular with Northeastern students and raised $2,000 to buy materials for the orphanage.
“While I was there, I noticed that the toddler area had a concrete floor. After seeing a couple of kids fall, I decided that something had to be done about it,” said Avery who works as an outpatient physical therapist at Emerson Hospital and is teaching an introductory PT course at Northeastern.
He researched flooring companies, found what he was looking for in California, and had the company ship him foam flooring squares in 50-pound boxes. He then arranged with the airlines for Hayward’s students the following year to take the boxes with them to Ecuador as checked luggage.
For Li Li, DPT’11, the passion for cross-cultural work has continued throughout her career. As a student, she volunteered along with Hayward on the burn unit of a Chinese hospital. After earning her DPT in 2011, she went on three of Hayward’s Ecuador trips as a volunteer teacher’s aide.
She now owns a physical therapy clinic in Chinatown and is the director of international rehabilitation services at the Hebrew Senior Center in Boston. She recently returned from a year in China, where she established a new physical therapy department at Jiahui International Hospital in Shanghai.
For Donat, the 4-year-old boy’s first steps was a particularly joyous moment. She too was adopted from a South American orphanage by an American family.
“When I was 3 months old, I was adopted from an orphanage in Colombia—just one country over,” she said. “I had always wanted to go back to South America, but it was pretty overwhelming when I first got there.”
Donat was so moved by the experience that after graduation, she volunteered for a second Ecuador trip with Hayward, this time as a licensed physical therapist. One little girl from her first trip made a lasting impression.
“She had been taken away from her mother for extreme neglect and had been at the orphanage for just two days,” said Donat. “She was suffering from malnutrition, seizures, and had a lot of behavioral issues. She held my hand the whole time.”
During her second trip, Donat learned an important lesson from the local caregivers.
“Two years later, she was a completely different child. She was happy and outgoing,” said Donat. “It was a reminder how far patience and kindness can take you, and the importance of building trust. The ‘tias’ love these children as their own, and because of that, each child blossoms and thrives in that environment.”