World Squash Association presentation (Saturday, May 24)

Mike quizzes the athletes - who wants a t-shirt?

Group picture of GHOI members and WSA participants!

After a long cab ride (~45 min in air-conditioned or for some, no air-conditioned "Cool Cabs"), we arrived at The Otters Club in Bandra. We met Amar, head of the World Squash Assoication, who quickly gave us a tour of the extremly nice facilities. However, we were in a rush to prepare the sessions and drills for the young athletes, so he led us to the squash courts. Three o'clock arrived fast and the kids were starting to gather. We gave them introductions and broke out into age-related groups, so drills and information were age-appropriate. We had four "stations" setup: warm-up, conditioning, plyometrics and strength training. At the end, we convened for a Q&A (question and answer) session, in which concepts that were taught to the partipants needed to be recalled correctly to "win a free t-shirt." The parents also joined at the very end for a Q&A session, in which they were able to ask group members about strength & conditioning. This ended up being a 1-on-1 session with the parents, but many of them left happy to gain this knowledge. Many of the kids, even the really young ones, were so polite and appreciative, as they thanked us before leaving. (We were also grateful as we learned from them too! During some of the activities, the children were able to teach us about proper mechanics and form of squash. Some of the members were able to join the kids for a quick teach & play game of squash!)
Afterwards, Amar and a few of the participants' parents invied us to stay at The Otter's Club for snacks and drinks near the pool and oceanside. We enjoyed ourselves thoroughly, as the view of the ocean was amazing and conversations with the locals was stimulating, as we talked about sqush and sports, travel, food, US and India. A few of our members even joined some of the children (who were at the program) for a game of "backyard cricket." The most rewarding points of the day were when we were all sitting with our snacks and tea at the table and the parents pointed out that the children are stretching after finishing up their activity AND they were asking for water to stay hydrated. That is really when we know we made a difference, as they were trying to make changes. Sadly, we had to leave this beautiful club, the families and the children, but fortunately we were able to walk out to a beautiful sunset! Sincerely, Mike

The highlight of the day (by Mike):
While working with the youngest group of partipants, I was trying to get them to stop playing on the physioballs but one child continued to play and bounce on it. I had no other choice but to physically remove it, as the child continued. As I tried to remove the ball, the child fell straight onto his buttock. I felt really bad and looked up to see Dr. Richardson staring at me. The child was fine, but I was scared!

Our last day at NAB (Friday, May 23)

Chris teaching the manual therapy techniques to the the NAB students while they feel his hands to learn the proper hand placement and movements.

Brienne and Claire speak to the NAB audience

So we are going to jump back to Friday, as we finish up our experiences with the NAB.

Friday morning was a bit of a "relaxing" morning...if you can call any of our days relaxing! There's just so much to see and do so we can get it all in! On Friday one group went to the Bombay Store to peruse and buy various gifts and Indian "knick-knacks" while the rest of the group went to get the chiffon Indian-style shirts (described by members of our group as the "ultimate wicking material" and "Indian UnderArmor"). These shirts were desired by many of the group members, to combat the heat experienced the day before. A room can get even hotter with 50+ participants performing manual therapy techniques in "what feels like" 100 degree weather (heat and humidity). Though the fans were surprisingly helpful, the shirts helped to cool our bodies during the teaching sessions. So this was our last day at NAB, the National Association for the Blind. Claire led the teaching of manual techniques for the spine, hip, and sacroiliac joint while everyone else continued to lead their small group of participants in hands on training.

Some comments from the group about our experiences at NAB:
Claire and Brienne: It was so fun to finally meet the people we have been corresponding with for over a year! Everyone was so humble and generous, and extremely gracious and inviting. It was interesting to see the differences between how we imagined things to be like and how they really were. We had been concerned about how the actual teaching of the visually impaired was going to go since none of have really done this before and didn't know what to expect. Working with a small group was good to give everyone the chance to both feel the technique as we were doing it, as well as try the technique on each other. It was surprising at first to have so many hands automatically feeling all over your own hands to "see" the technique. But after a while it became natural for us. I think as physical therapists we are used to using our hands a lot, so we were able to quickly adapt to teaching those with visual impairments. At the same time, it was impressive how quickly the participants caught on. It makes sense though, since they are so used to using their hands to interpret the world around them that they would learn quickly how to manage new technqiues with their hands to be applied to the human body. Finally, this group of current and future physiotherapists were inspiring. They in no way let their impairment limit them. We were so impressed with not only their knowledge and skills, but mostly their thirst for new knowledge. It was motivational for us as newly graudated students just coming out of school and feeling somewhat burned out -- we were able to see how excited it can be to have new experiences in physical therapy even beyond our formal education.
Melissa: One student (who was totally blind) asked Melissa to "take a picture" which really meant he wanted to video record her on his phone while doing a mini-interview to include information about herself so that he could remember her! During our tea break, we recieved umpa, which we could only describe as tasting like grits with veggies (but not so liquidy as you're probably imagining). It was made by "Mousey" (not sure on the spelling--but it means "Auntie").
June: Actually, I would suggest that the umpa could also be described similarly to chicken pot pie. Just thinking about it now makes my mouth water. The staff and students at NAB were extremely warm and friendly, as they opened up their school for us for three days and we will always be grateful for his experience! They provided us with everything we needed and gave us back much more! I hope that we get this opportunity again, as it was fun and rewarding for everyone involved!
Chris: Several of us received mahendi on our hands at the end. We spent over an hour giving out business cards and taking pictures (even the camera men wanted to pose in pictures with us!), and during this time Dr. Purnima (one of the NAB faculty) drew henna-like designs on our hands or forearms. She gave us the remainder of the cone so we could do more for the people that didn't have a chance to do it. Kara even tried her own hand at it and drew Rachel's design!
Mike: One of Mike's group members asked about pursuing further education as a physical therapist in the US. He was totally blind, but he probably had some of the best manual therapy skills of anyone in his small group! Mike was very encouraging and told him not to let go of this pursuit but to never take "no" for an answer.

At the end of the day, we left NAB meet the Mathurs at Bombay Blue for a mix of continental and Indian cuisine. The highlight: puffy balloons of fried dough (similar to puri, but I can't remember the name) and sizzling brownies from Mrs. Mathur (as a congratulations for completing our service at NAB!) Again, a very filling meal at 10:30 PM, but most enjoyable as Mr. and Mrs. Mathur made great suggestions on appetizer and entree choices.

Sincerely, Brienne & Claire

Monday, May 26th, 2008 - Saiffee Hospital & Elvis

Melissa here to recount our Monday adventures in Mumbai.
We were up early and in professional attire for our 2nd trip to Saiffee Hospital, a private hospital which overlooks the water and has been described as pretty as a hotel. At night you can see the lights of Saiffee from Marine Drive, the Queen's Necklace.
Professional attire to us means those nice wool suits or poly blends in black. Now add 100 degree weather plus 80% humidity and see how well you do in black polyester. This is a recurrent theme since we saw Elvis later in the evening in polyester and leather.
The professional dress that we were met by were nice kurtas and saris on the women and suits and ties on the men (no jackets that I saw though)
We were at Saiffee from 9am until 4pm. They have a very lovely auditorium with a reception area were we had lunch and broke for morning tea. Yes, they even take morning and afternoon tea during the regular work day in the hospital. The physiotherapists were coming and going throughout the day and many of them wore labcoats.
To give you a rundown of events:
In the am - Dr. Writer, the head of the Nieere (I completely massacred the spelling of that hospital but I do not have her card on me. That spelling is more for pronunciation.) Hospital Physiotherapy program - the Hindustani equivalent to Dr. Jan Richardson; she spoke to the audience on vestibular rehabilitation and then had 2 of her students present 2 different case studies for the room to discuss. For both of the case studies the patients were present with family and walked in front of the room. 1 case was of a 52 year old man with a 2 year old stroke with definitive right sided foot drop and hip circumduction. He did not have an AFO or an assistive device and his complaints were of being unable to walk more normally especially to safely walk across the street. Having spent a week in Mumbai by this time, I understand the absolute necessity to be able to safely and quickly cross the street. The cabbies don't stop, just honk!
The second case was a man diagnosed 1 and 1/2 years previously with Parkinson's and the question to the group was about how to progress his treatment. One of the major things we learned from this case study is that the physios here take alot of psychological/ psychosocial data into account and specifically use tests and measures to quantify depression or other issues that may be present.
Dr. Chagla, the neurosurgeon that we had met at breakfast at the Bombay Gym on morning 1 in India, got up to speak about "Sharpening your axe" - keeping up to date on research to be a better clinician.
Then 2 of the physiotherapists at Saiffee got up to present on biomechanics of the patello femoral joint and treatments of patello-femoral pathologies, specifically arthritis.
Dr. Pispoti, a rheumatologist who connected with us when we first wandered the halls of Saiffee hospital and discovered that he and Dr. Jan Richardson were both members of the Rheumatological Association (again - most likely got that name wrong but it's late for me writing this). He spoke to the group about discovery of joint pathologies via physical examination findings. It helps to reinforce the role of the physio for observing the big picture and referring out when necessary.
The Dr. Reepa Shroff, an occupational therapist, gave us an overview on Attention Deficit and Hyperactivity Disorder (ADHD) and Sensory Integration for the paediatric population. As I am a paediatric physical therapist myself, I was especially intrigued by this topic. My favorite line of hers is that "the child is the director but every good film needs a screenwriter/ the therapist."
Then we broke for lunch and had typically Indian Cuisine. The a couple of people in our group decided that the dessert, a coconut type milk with a sweet bread floating in it, reminded us of a bowl of milk that fruit loops had sat in for a while - that sweet milk flavor.
I sat between 2 very nice physios and we chatted. I have been continually amazed at how different the English language sounds from different parts of the world. I am sure that we, on both sides of the conversation, asked each other to repeat ourselves multiple times.

After lunch was our turn to present. Dr. Rachel Beck and Dr. Brienne Thorusen spoke on Evidence Based Practice. Dr. Michael Tamaddoni, Dr. V. Claire Maranto and myself spoke on the treatment of children with Cerebral Palsy in the United States, and Dr. Kim Elzinga, Dr. Chris Moldan, and Dr. June Lohner spoke about a Low Back Classification System as per Delitto et al.
I think the presentations went over well, especially since I got multiple email addresses with requests to send them our powerpoints and more information on other various topics.
Lastly, we were provided a tour of the rehabilitation facilites, the entire 9th floor of Saiffee. 2 things of note that we thought were particularly interesting was an electromagnetic bed for arthritis and also a CPM (Continuous Passive Motion machine) for the upper extremity.
That evening, we headed to meet Amar Hocksar and the Mathurs for a night at CCI (Cricket Club of India) with dinner an an Elvis Impersonator.
It was a very fun time in which we ate a mix of italian and lebanese cuisine and then danced to Elvis tunes.
The impersonator was very good vocally and in appearance (a younger version of Elvis in physique) but as Mike noted, his hips were just not right. Might have been because of trying to squeeze in black leather pants in Mumbai in the summer for an outdoors concert. He sang all the classics though, Love me Tender, Jailhouse Rock, and Teddy Bear. The group of us plus a small handful of the other patrons got up to dance to the King. We had a great time and I thought I had never sweated more until we got to Goa.
Of note, Kara Richardson, "swooned" when Elvis threw his scarf at her. Then she, as well as I and a few others of our party got our picture with him!
Last detail of the day - Happy Birthday Shefali! She turned 25 on this day and we went after Elvis to the Mathurs home to sing her birthday wishes and to have lime soda and mango and coconut ice cream in her honor. We were sad not to have Shef there especially on her birthday, but she was in our thoughts as we ate some of the most amazing ice cream ever. I highly recommend Mumbai in mango season.
Well it was a busy but fufilling Monday in Mumbai.

Mumbai City Tour

Visiting the "outside" laundromat

There was an elephant behind us...

Mumbai City Tour (Thurs, May 22)

Today we finally had a chance to catch up on our sleep…well sort of. Mike, June, and Kim went for a run along the “Queen’s Necklace” and met up with Shefali’s mom at 6:00 this morning. The rest of us slept in before our second big shopping day. A few went to the "electronic market", as the majority of the group thoroughly enjoyed themselves as they shopped for jewelry. Don't worry, their will be a second field trip to that area of town. Both groups enjoyed a drink during their shopping adventures. The electronics group was served lime juice and four glasses of chai masala hot tea (delicious!), which was prepared with cream and sugar. The jewelry shoppers enjoyed coconut water, which was refreshing on an extremely hot day in Mumbai. After shopping for a few hours with Shefali’s parents we were off to the National Association for the Blind for our first day of teaching.
There were 35 participants who were there for our 3 hour presentation on manual therapy that focused on mobilization techniques for the shoulder, elbow, knee and ankle. Brienne led by providing initial instructions to the group, which consisted of a DPT student, a group of blind students and NAB practicing physical therapists. It was quite an experience, as it was challenging to teach blind students how to perform joint mobilizations. However, by the end, each one of us felt we learned just as much as the students and NAB PTs and developed many good memories from this teaching opportunity. We are looking forward to going back again tomorrow to finish up our workshop, which will focus on techniques for the hip, sacroiliac joint and spine.
We then were off to have drinks with none other than the famous Grandma Mathur! (Shefali, thanks for the suggestion!) She was all we had expected and then some! Talk about a sweet and amazing woman! It’s not hard to see where Shefali gets her sweetness (and spunk). We also had an opportunity to talk to Shefali, which was a great chance to catch up on events on the the trip. Group pictures at the Mathurs and then we were off for supper. We went to the Golden Spoon for veggie thali, which for the non-indians out there is a big silver plate with little cups in it. Look at the pics. Then a swarm of servers engulfed us and filled all the cups with a variety of vegetarian delights. The service was great, the food was delicious and again, we left there extremely full. It was absolutely amazing!
That’s all for today’s post. There will be more in the next few days.
Sincerey, Chris

What an experience! (Wed, May 21)

It was like Christmas morning!!!! We woke up to a phone call at 6:45 am informing us our luggage arrived. A few people stayed awake during the late night to ensure the "arrival of their gifts", as another group got a knock on their door to wake up. It was perfect! So we ran downstairs to find all our suitcases wrapped in saran wrap and “impossible to break” rope, but “not resistant” to the concierge’s scissors. After a few short minutes of excitement, the group took advantage of the opportunity to work out at the Bombay Gym with Zubin (our host/travel coordinator). Some were adventurous and learned how to play squash, and the rest of us were trying to avoid heat stroke by walking/jogging around the rugby fields and engage in yoga activities. Wow, it was definitely a hot and humid day. To get >30 minutes running in would be enough for anyone!
Our next plan was to go on the "City Tour of Mumbai". We were accompanied by “Mark” on a tour of Mumbai. Major sights included: the Mumbai train station (which transports millions of people into and out of the city every day), the Hanging Gardens (famous Bollywood love scene filming location), the house Ghandi stayed in (with famous quotes and information on his courageous life), and the open air laundry facility (where you can pay to have your clothes washed by hand). We learned the true meaning of “30 more minutes for the tour” actually means 2 more hours…as we missed our lunch reservation. A group of five went to Mucambo for a quick lunch. A good suggestion would be "order the mango lassi". If you have never had it, it's a like a mango milkshake. Try one!
Later in the afternoon we were escorted to the National Association for the Blind (NAB), an NGO which trains visually impaired individuals for community integration. We were greeted with a traditional Indian welcome which included presentation of gifts, formal introductions, and a candle lighting by our “Distinguished Guest of Honor”…J-Money! Visually impaired students from NAB gave us a tour of their facility and demonstrated how they studied using a computer voice program. They performed specific modalities and interventions. Originally we thought we would be presenting to students; however, alumni and other healthcare providers also were in attendance. The participants and “faculty” (yes, we are the faculty) spent time discussing logistics of our 3-day seminar on “Manual Therapy for Joints.” Check back tomorrow for more details…
Dinner was hosted by Amar, a former squash coach of Shefali's brother at the Cricket Club of India, where the national team plays. It was a great dinner, as the service, food and company were of the highest level. Another day that we went to bed on full stomachs. We filled up on naan, garlic naan, tikki chicken, prawns, a fish dish, tostadas and so much more from the Indian and Chinese cuisine. We even kept some room fresh mango and ice cream, along with tea/coffee. Yes, mangoes are in season in Mumbai. Come right now! Everything was amazing!

Sincerely, Rachel

Wow, we're in Mumbai! (Tues, May 20)

Sorry, we didn't mean to keep y'all hanging on our luggage issues! We were already made aware that our bags would not be coming in until after 11 PM later that night, with an uncertainty of its arrival to our hotel. So yet another day wiithout our luggage.
We started off our morning by joining Zubin, our trip coordinator and host, at the Bombay Gymkhana. He introduced the group to dosas, a large baked crispy crepe that everyone really enjoyed. We ordered a continental-like breakfast and drank multiple bottles of bottled water for our saftey. Some were brave enough to try the masala omlette and variations of dosa. It was a good way to start off our experiences with Indian cuisine.
After breakfast, we joined Mrs. Mathur and her friend, Shaama for shopping. Many of us did not bring much clothing on our carry-ons, so shopping was a necessity. We were very excited to get out of our "old" clothes and into some beautiful Indian kurtas, pants, and shoes. We were definitely styling and looking fashionable with their help. After a morning of shopping, we were hungry and had a delicious Chinese meal at Ling's, which served fresh fish (palm freet), jumbo prawns on skewers, and spring rolls (and that was just appetizers!). For our main meal, we ate white rice with bacon/shrimp, ramen noodles with peas/carrots, chicken and veggie stir-fry. Unfortunately, this is only just a few of the entrees, as it is hard to remember everything. It was a great variety of foods that tasted like Chinese food with an Indian twist.
After lunch, more shopping continued and clothes just weren't fitting us the same (just kidding). We finished and headed back to the hotel to change into our new Indian garments. Our next visit was to Saifee Hospital, a private hospital, in which we visited Dr. Chalaga, neurosurgeon and a few of the physical therapists. We were able to see their Primus system, which is a machine that trains patients, more commonly athletes for their specific sports. It is similar to what we know as a Cybex or Biodex machine but more elaborate. We were informed that only a few of these machine exist worldwide and many professional and elite international athletes have trained using this. We were very excited to have been introduced to it. We will be heading back to their beautiful facilities on Monday for a full day of presentations and a hospital tour.
We then headed to Bombay Gymkhana to eat dinner with Mr. and Mrs. Mathur, Zubin, Dr. Chalaga and a few other members from the club. We had a variety of Indian cuisine, which included tikki and prawn masala, byrani, naan, Indian sausage, along with a lot of other main dishes. We finished our meal with mangoes and pistachio ice cream!
After this long day and jet-lagged, we were very tired and were ready for a restful night.

No Bags? (Mon, May 19)

After getting off the plane, we grabbed some hand carts to "carry" our bags. However, 10 minutes after the belt stopped distributing baggage, we were wondering, "where were ours?" So despite our efforts of running to make our flight yet going slow enough to give our luggage a chance…no bags in Mumbai! We spent over an hour individually giving our information about our bags (down to the type and color) and hotel location to an incredibly patient Continental representative. We then had more paperwork to get us through customs and get our missing bags cleared through customs so they could be delivered to our hotel after they (hopefully) arrived on the next flight. Our bags were likely held back in Newark, NJ becaues were rushing so much to catch our connection flight. Once the group was finished with paperwork, we walked out of the airport at around 11:30 PM, we walked outside to see a mass group of people (like hundreds) awaiting the arrivals. As we walked out, we saw a "WELCOME DUKE" as we were met by "Caps" (Shefali's dad) and Aarti (Shefali's mom) Mathur, along with a gentlemen associated with the World Squash Federation to ensure for our safety and transportation. The entire feeling was like we were walking from the stage after performing a show as they escorted us to the bus. We were led to the bus, which was complete with decorative lights and curtains. Does anyone remembers was like a "hippie bus" or can imagine an "Indian party bus". Yes, we are in India. We had an early introduction to traffic asour driver skillfully maneuvered around the airport parking lot and through town with only a few grimaces as we got a little close to a few buses, cabs, and pedestrians. (Shefali, we saw "Queen's Necklace" at night! What a beauty!). We arrived at our hotel and sorted out rooms and roommates (without much baggage). We had sandwiches and bottled water provided for us by our local hosts which we quickly divided up and then headed to bed! We’re still working on resetting our internal clocks, but hopefully that gave us a good start to actually sleeping when it’s night over here!

On your mark, get set, let's fly to Mumbai

There was no better way to start our trip than to be sent off by our own, Dr. Shefali Mathur, who graduated with the Doctor of Physical Therapy (DPT) Class of 2008. As stated before, she has been a crucial part to initiating the Globoal Health Outreach Initiative in India. There were a few tears as she was happy to see us go but disappointed that she would not be able to join us for our adventures. Also, we were extremely suprised by the presence of Dr. Daniel Erb, the Director of Student Affairs in the Doctor of Physical Therapy Program at Duke University. He met us at Raleigh-Durham Airport to see the newly Doctor of Physical Therapy graduates setting off to India, as this was one of the newest chapters in their lives. However, none of us knew what was going to be in store.

FYI: This may be a little too descriptive but you have to understand the details to understand our dilemmas. Our adventures started when we checked-in our luggage and noticed that our flight was delayed. Instead of leaving at 5:10 PM, we were held back 35 minutes (likely due to inclimate conditions at Newark Airport in NJ. We finally boarded our plane but continued to sit and taxied on the airplane for another 45 minute. The flight was bumpy and turbulant but we made it in the estimated time of arrival. Due to the delay from RDU to EWR, we were very rushed to get to our connection flight at 8:20 PM. We literally had less than 10 minutes to get off the plane and run to the terminal. When I say run, we ran! Kara and Chris ran off the plane and into the terminal gates to make sure that we could make the plane. Fortunately they were able to get the airline attendants to allow a few more people on the plane. They re-opened the gates for us. It probably took all eleven members to reach the gates within 10 minute, as we had to navigate across the aiport terminals. After sitting for a few hours previously, it was difficult to sprint. And it was not like we were trying to run towards the plane, knowing that we were going to be sitting in the plane for the next 14 hours. After about 6 hours of sleep or "resting your eyes", watching 3-5 movies (by the way, August Rush is the cutest movie ever!), playing 1-2 video games, and/or reading books/magaizines, WE MADE IT to Mumbai, India!

Our apologies

I want to apologize from the start for the delay of starting the blog. There were some issues, which will be described later on the blog that delayed the creation of this blog. Utilizing a different power source and not having internet access was the least of our problems. Our sincerest apologies! However, although we were delayed, you will be thoroughly entertained by our stories. If you have any questions, suggestions or comments, please feel free to post a note on our blog. We will make sure to address it. Pictures will be updated very soon!

Bon Voyage!

The day has finally come! The DPT GHOI 2008 will be traveling to Mumbai, India in less than a few hours! Right now, many of us are running around trying to pack our bags and pick up last minute items. I know I am! We are very excited to have you join us in our adventures for the next three weeks as we travel throughout India. During this time, we will have multiple posts by many of the travelers. Stay tuned! We hope that you enjoy our stories, pictures, videos, etc, so you feel like you are with us. Thank you so much for all your support in helping to make this happen.

Sincerely, June

P.S. Thank you to Shefali Mathur, who just a few years ago, desired for a physical therapy trip to India. Your dream has come true! Though you cannot be with us, you'll be with us in spirit! We know you'll be following along on the Blog! We hope we can make you proud!