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Division of Physical Therapy
UNM Health Sciences Center
MSC 09-5230
1 University of New Mexico
Albuquerque, NM 87131-0001
Phone: 505-272-5479
Fax: 505-272-8079

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The UNM Division of Physical Therapy Returns to Ethiopia

The UNM DPT Program recognizes the importance of service-learning and its link to building future leaders dedicated to serving and advocating locally and nationally for the health of individuals and communities.

Dr. Burke Gurney, UNM Emeritus Professor, established the service learning program in Addis Ababa, Ethiopia and led the first group of students in 2018. In May of 2019, students Chanae Esquibel, Ryan Fresquez, Kevin Williams, Rachel Granzow, and Luke Chavez accompanied trip leaders Dr. Deborah Doerfler, Assistant Professor, and Dr. Julie Jordan, Adjunct Faculty, to Addis Ababa.

Service-learning settings included Tikur Anbessa (Black Lion) Hospital, Paragon Physiotherapy and Sports Medicine Clinics, and the Adult and Pediatric branches of Missionaries of Charity. The clinical experiences were diverse, from providing skilled physical therapy to patients with complex neurological and orthopaedic conditions to working collaboratively with staff and educating technicians, patients, and family members at Missionaries of Charity.

Ethiopia Service Learning

Upper left:UNM DPT Students beginning their first day at Black Lion Hospital: Rachel Granzow, Chanae Esquibel, Luke Chavez, Ryan Fresquez, Solomon Legesse (our astute driver and guide), and Kevin Williams

Upper Right: Kevin Williams, local PTs and Dr. Mekonnen sharing a laugh during their “group” mobilization technique.

Middle Left: DPT students Chanae Esquibel and Rachel Granzow provide training in splinting the upper extremity and positioning techniques to reduce the risk of contractures at MOC.

Middle Right: DPT student Ryan Fresquez and Dr. Hiwot Zelalem providing physical therapy to a patient at Black Lion Hospital.

Lower Left: Last day at Missionaries of Charity

Lower Right: Student providing manual treatment to a women with spinal dysfunction at Black Lion Hospital.

Similar to the University of New Mexico Hospital and the UNM Health Sciences Center, Black Lion Hospital is the academic medical center and primary teaching hospital for Addis Ababa University. It serves over 300,000 patients annually providing healthcare for the residents of Addis Ababa and surrounding rural communities. While the hospital is the main tertiary referral center of Ethiopia, it lacks the resources to meet the enormous number of medical needs of its patients. Similarly, there is a critical shortage of physical therapists, yet the need for physical therapy services is vast. We were fortunate to work with clinical instructors, Dr. Winnie Mekonnen and Dr. Hiwot Zelalem, both graduates of the only DPT program in Ethiopia. It was common to see patients at Black Lion Hospital who traveled many miles for PT services. For example, one patient who worked as a house cleaner traveled over 400 miles. A local charity provided shelter for her, while she received daily physiotherapy over the course of two weeks. All PT students remarked on a consistency they observed among patients treated at Black Lion Hospital: the diligent adherence to their home program, and how it paid off with remarkable progress in a very short period of time.

Dr. Theodros Gebriel, DPT and owner of Paragon Physiotherapy and Sports Medicine Clinics, generously provided opportunities for the students to expand their manual therapy skills while seeing patients in an orthopaedic setting. Dr. Gebriel and his PT staff are dedicated to providing western standard-of-care to patients while serving as a model of excellence for physical therapy in the Ethiopia healthcare system.

Missionaries of Charity (MOC) was founded in Calcutta, India by Mother Theresa in 1946, with the goal of serving the “poorest of the poor”. Since its establishment, MOC has expanded to multiple locations around the world. All students agreed that the experience at MOC was unforgettable.

Ethiopia Study Abroad

Upper left:Dr. Julie Jordan demonstrating a shoulder manual therapy technique during an educational session for local PTs.

Upper Right: Students enjoying “injera” the traditional sourdough flatbread used as a spoon to scoop the spicy stews and vegetable sauces.

Middle Left: The pediatric campus of Missionaries of Charity in Addis Ababa.

Middle Right: Students and instructors took advantage of the Derg Downfall National Holiday to hike in the Menagesha National Forest, near Addis Ababa. Black and white colobus monkeys, baboons and endemic forest birds were sighted during the visit.

Lower Left: We toured the National Museum of Ethiopia that houses the archeological findings of “Lucy” and “Selam” (an adult and a 3-year old female hominin – a distant cousin to modern homo sapiens) estimated to exist 2.2 and 2.3 million years ago.

Lower Right: Rachel Granzow and one of the MOC technicians discussing pathoanatomical dysfunction of the pelvis.

 DPT student Chanae Esquibel provides her perspective:

MOC has been one of the most amazing experiences of my life. I am truly thankful for this experience; it opened my eyes to the perseverance of individuals and the need for educated healthcare workers around the world. MOC had roughly 600 individuals sheltered in a men’s and women’s ward. There were different rooms for different diagnoses; for example, tuberculosis, wound care, bed ridden, and heart/liver disease. The therapy gym was located next to the women’s ward and the PT treatment worked like an inpatient and outpatient rehab unit. Some individuals would walk or wheel to the gym, some villagers would bring their children from outside of the ward, and many of the sicker patients would be seen at bedside or brought to the gym by the staff. Some of the patients whom I remember most included an individual who sustained a spinal cord injury a year prior from a motor vehicle accident. Her sitting balance was adequate, but when asked to go to a prone position it took two individuals to assist her. She was able to transfer from her wheelchair, but she was at risk of shoulder pathology due to improper technique. We were able to educate her and the techs on “head-hips” and rolling techniques. By the time we left she was rolling independently and using head-hips to lift herself onto an elevated surface. A patient with extensor tone was able to stand after we educated the techs on techniques in the parallel bars and show them proper positioning on how to use her extensor tone to their advantage. A four year-old child with spastic quadriplegia came to MOC from the village. A children’s book that we included in our donated supplies from NM, and a new experience for this child, served as a great facilitatory technique to promote visual tracking and head control. Last but not least, is the patient who touched my heart the most and will stay with me for the rest of my life. She was a young adult, who suffered a traumatic brain injury (TBI) and hip fracture. The injury occurred eight months prior, she had been at MOC for 22 days but had not been out of bed. Multiple joints were becoming contracted and she was at high risk for skin breakdown. Her mother was there every day/night trying to help her daughter to the best of her ability. Communication to the patient and family was limited and the patient was resigned to the bed for most of the day. We educated the staff and mother on positioning, using pillow splints for elbow and hand contractures, and the need to get her out of bed. By the time we left (only two weeks) her joint motion had improved, she was sitting at the edge of the mat with one hand support and stand-by-assist. We were able to educate the staff on prone positioning, the importance of upright positions and even managed to get her in an old standing frame with the use of many scarves and people! She was more alert and oriented, attempting to communicate with everyone by grunting and hand gestures, and had a smile that lit up the room. She began progressing to bridging and rolling side to side using the bed rail. This allowed the staff to engage with her more and see that she was “there”. We educated the staff on the progressive changes that can be expected in many patients with TBI, the outcomes and prognosis that can occur and the importance of getting her moving and engaged. She and her mother were so grateful! This taught me the profound impact education can have on outcomes, which I will continue in the care of my patients.

Perspectives from other DPT students on their experience in Ethiopia:

Ethiopia is an amazing place. The people, the food, the market, and the city were like nothing I had ever experienced before. It is one of the most culturally diverse places I have ever been. I really enjoyed the time I spent at Black Lion. It was nice treating patients with a classmate and with a local PT. I also learned that PTs in Ethiopia can give injections, prescribe medications, and order imaging. This trip gave me first-hand experience on the importance of being culturally sensitive. This will help in my practice as a PT given that we live in a very diverse state.

I know we made a difference not just in the lives of the patients, but we taught the staff new things that they will be able to take into the future and help many more patients to come. It was so rewarding to put into practice everything we learned in neuro this year to help people who really needed it. Coming here allowed me to see things I would probably never see in the US. It was also a great chance to learn how to teach the things I know to other staff members, much in the same way as I may have to do in the future with techs or PTAs. The teamwork with everyone there was a great experience and I felt very proud of everything I was able to offer. I will never forget the patients I saw! They made such an impact on me. They were hard working, with great attitudes, and a dedication to their own care. I'm so grateful for this experience.

With even less equipment, and generally greater comorbidities, it was often a challenge working with these patients. Here we became more of the teachers rather than the learners, which provided us a great opportunity to practice the skill of teaching. With a language barrier we were challenged even more but were able to communicate effectively enough to get our points across. I am more culturally sensitive after this trip. The people there act differently from the people here in the states and handle pain differently as well. I know not to assume that people are the same and this trip was a great reminder of how different people really are. I feel that I can handle situations like minimal equipment, resources, or lack of communication better than before.

The things I learned were pretty valuable like how physical therapy is done in that country and how to adapt to a different culture and group of people. It was also valuable because you don't have many resources so you have to improvise, which is something I have done before, but not quite to this extent. I liked how we were able to see some of the same patients and make a difference in some that had not experienced a prior difference.

UNM Division of Physical Therapy Expands its International Reach

The University of New Mexico Physical Therapy program - and the UNM PT students - have long made a commitment to service learning, both in the U.S. and abroad. This spring, to help fulfill that commitment, five students, Tatenda Chibanga, Sean Horner, Troy Jaramillo, Jonathan Lewis, and Lisa Peterkin accompanied PT Division Chief, Dr. Burke Gurney to Addis Ababa, Ethiopia to provide skilled physical therapy treatment for those in need. For two weeks, the students spent their mornings treating outpatient orthopedic and pediatric patients at Tikur Anbessa Hospital. While there, each student was paired with a recent graduate of Ethiopia’s (and in fact Africa’s) only DPT class to date. This allowed students to develop their skills and exchange knowledge with their Ethiopian counterparts - as well as serve the community in a meaningful manner.

PT Students

The students at Addis Ababa University on the first day of clinic

Tikur Anbessa - or “Black Lion” - is a teaching hospital similar to UNMH. Like UNMH, it is associated with a University, Addis Ababa University. In the center of the city, future nurses, MDs, PTs and pharmacists attend classes and treat patients and, after graduation, many practitioners choose to stay at Black Lion and continue to practice. Named after a resistance movement that fought the occupation of Ethiopia during WWII, Tikur Anbessa is a 600 bed hospital that sees over a quarter of a million patients per year. Thanks to a robust orthopedic surgical department and a high prevalence of childhood disability, many of these patients receive physical therapy as part of their health care management.However, treating at Tikur Anbessa differs from UNM in many ways. The hospital is located in a city of five million people - nearly ten times that of Albuquerque - in a resource poor nation. The crush of population is evident in the twenty-thousand to one patient-to-doctor ratio in Ethiopia. Because of this imbalance, wait times for treatment throughout Tikur Anbessa are long - and the PT department is no different. Furthermore, due to the scarcity of resources, the hospital is often subject to rolling brownouts and often has to switch to generator power for some or most of the day. In addition to the frequent brownouts, the water went out in our building for a day. Finally, unlike UNM, Tikur Anbessa is often critically short on supplies. This shortage means that physical therapists must rely only on manual therapy and exercise therapy for their patients. However, because of this, the therapists are left to their creativity to make do. They do amazing work on a daily basis with very little.

Oromia, Ethiopia

A pastoral scene in Oromia, Ethiopia

In the afternoons, students would either accompany Dr. Wintana Mekonnen, a DPT graduate from Tikur Anbessa, to her private outpatient orthopedic clinic or they would join Dr. Gurney at the Missionaries of Charity Home for the Sick and Dying Destitutes to treat patients with advanced neurological and orthopedic conditions. While at Missionaries of Charity (MOC), students treated patients that truly had nowhere else to go. The Missionaries of Charity organization, established by St. Mother Teresa in 1950, attempts to provide “whole-hearted free service to the poorest of poor.” The Missionary home located in Sidist Kilo, a suburb of Addis Ababa, serves meals to 900 people daily and houses many of these men and women who have nowhere else to stay. 

Daily treatment and care at MOC is generally performed by 6 technicians with no formal education - but all have a great deal of commitment to their patients. These techs treat in two small rooms with very little equipment while still managing to make great progress with many of the patients of MOC. Every day, this small group of technicians see patients with a variety of diagnoses including muscular dystrophy, stroke, HIV-derived neurological conditions, developmental disabilities, orthopedic impairments, to name a few. In the MOC, the UNM students treated patients while trying to educate the MOC technicians and help them to expand their skill set. This focus on education with treatment ensured that the student’s time here would have a lasting impact and would benefit MOC far into the future, rather than just during the two weeks of treatment.

Treating a patient

Troy Jaramillo, SPT, treating a patient with severe contractures at Missionaries of Charity

For those students that accompanied Dr. Mekonnen to her private practice - Oslo Addis Physical Therapy and Wellness - the patient population consisted of adult patients with orthopaedic and neurological conditions, as well as pediatrics. Because Oslo Addis PT is a private clinic that accepts both insurance and self-pay, the socio-economic status of the patients there was different from those at either Tikur Anbessa or MOC. At Oslo Addis, the students worked with immigrants from across Africa, athletes, laborers, and everyone in-between.
In all three of these settings, the students found that the most difficult aspect of treatment was the language barrier. While the official language of Ethiopia is Amharic, there are over 80 different tribal languages spoken throughout the country. This often meant that the students were trying to treat patients through up to 3 levels of interpretation. In addition, many of the children and adults with neurologic conditions had trouble communicating in their own language, which compounded the difficulty experienced by the students. However, one thing seemed to be near universal among patients: they would often tell students that they didn’t feel like their therapists were doing their job unless the treatment was somewhat painful - this was a completely different mindset compared to many American patients. Due to this attitude, the students often described their patients as “tough,” “resilient,” or “brave.”

Tea time

The students and Dr. Gurney enjoying a traditional tea with Dr. Winona Mekonnen, a DPT from Ethiopia

Treating in these settings allowed the students to learn a great deal about the Ethiopian culture - about the culture’s warmth and Ethiopians’ trust in doctors and authority figures; about many Ethiopians’ easy smiles and willingness to undergo great pain to find healing; about their tendency to independence while still developing strong friendships; about the quiet strength that even the sickest of children displayed. While the students learned new techniques, evaluation skills, and treatment approaches from excellent clinicians, it is probably the strength they saw displayed by each and every patient - and each and every Ethiopian DPT - that most impacted them. Treating patients with so little who still fought so hard at each and every session was truly inspiring to every one of the student’s and they will be forever grateful for the experience.