Mission 2016

Treating in rural areas requires adaptability and flexibility from the osteopath!

Treating in rural areas requires adaptability and flexibility from the osteopath!

How was I to feel when this now 15-year old girl whom I treated 2 years ago in Nagar, came to visit us on our first day of work in this remote mountain village of Pakistan?  She reported that after one osteopathic treatment, her practically daily fainting episodes were completely resolved.  I felt happy and gratified. Most importantly, I felt our efforts for the last ten years, to bring osteopathy to Pakistan were worth every hurdle.

I traveled to the mountains this year with Haider Ali and Usmara Zafar, the first 2 osteopaths of Pakistan. Since 2007 Osteopathy Without Borders raised funds to pay for their training at SICO, the Swiss International College of Osteopathy, a branch of the CEO, College d’Etudes Ostéopathiques, in Montreal.  During our yearly humanitarian missions, we typically travel with a few volunteers from Montreal, but this year there were no candidates. Luckily, Haider and Usmara are now fully trained and effective osteopaths so our small team of three could provide significant help to the patients who came to us in Gilgit, the main city in the mountains, and Nagar, a remote village.

Walking lesson with Amjad after his treatment

Our favorite clinic: Haider treating outdoors in the palace garden.

Our favorite clinic: Haider treating outdoors in the palace garden.

Haider also had reasons to feel particularly good about his treatments: Amjad, a bright 15-year old cerebral palsy boy, came proudly to stand in front of us: he showed us how he used to stand, with knees and elbows bent at almost 90 degrees. Two years ago, after he received his second osteopathic session ever, he was immediately able to lift his feet better while walking and progressively straightened up. When osteopaths treat patients with cerebral palsy, a condition that responds well to osteopathy, treatments have to be regular over long periods of time. This exceptional result was due to the specificity of this boy birth-lesion patterns.  Osteopathy was able to make full use of the potential that existed. I treated this inspiring boy this time, and ended the session with some gait training to help him further his progress.

We have been returning to Nagar almost every year since 2008, and our commitment to supporting the villagers has been worthwhile. Every year we get more and more appropriate patients: in addition to the usual cases of pain, headache and stomach ache, we treated cases of infections, fevers and many patients with fainting and vertigo, the word having spread around.

Imdad and Khairullah on our way to our workplace in Nagar

Imdad and Khairullah on our way to our workplace in Nagar

We must thank our local team for organizing our 4 days in Nagar. Firstly Ibrahim Muhammad Khan, mountain guide and teacher, whose commitment to promoting osteopathy makes him a full member of OWB. He is with us from the moment we land to the moment we leave Gilgit, and makes sure we are safe and well-taken care of every step of the way. Most importantly, he directs patients to us, as he seems to know everyone in the valley. Imdad Hussain is a principal at a group of private schools and together with Ibrahim, they have done a great deal to educate other teachers and the population about the benefits of osteopathy as well as being instrumental in spreading the word about the harm of the local tradition of flattening the babies’ heads at birth. This tradition to beautify babies by swaddling them tightly on their backs with a pillow under their heads, or worse, binding their heads, creates rigidity in the cranial base, which affects function through the cranial nerves, particularly the vagus nerves that control the autonomic functions like digestion. They were happy to report, and we could notice, that the younger children are more often left with their natural shape. Still a long way to go until the tradition is eliminated from the valley but the progress is significant. Our deep thanks also to Kharullah Nagri, a young dental technician back to Nagar after traveling the world, who helped triage the patients and could provide some feedback later on.

Her cute baby sister, with her head squeezed at the hairline

Her cute baby sister, with her head squeezed at the hairline

2-year old treated by Usmara

2-year old treated by Usmara

We treated a family that gives a good opportunity to explain some principles of osteopathy: the first patient was a 2-year old girl who would faint whenever she cried a lot. She would stay unconscious for up to 90 minutes each time.  She had some deformation of her skull, that were signs of compression during the late stage of the pregnancy and/or during delivery. Her treatment went well and Usmara could release tensions of her cranial base that must have caused the dysbalance in her nervous system. Outside the treatment room, we met the child’s baby sister, a healthy 2 months old who we could see had an even worse skull deformation.  It was our opportunity to offer a preventative treatment. With such visible deformation, we knew this baby could not function at her optimal level of health. Osteopathy is a wonderful preventative medicine, as we can find mechanical restrictions that weaken the physiology before symptoms manifest. But then, the best prevention was to treat the mother: if the second daughter had even worse deformations than the first, the cause must lie in the anatomy of the mother. Sure enough, we found mechanical strains and tightness in her cranial base, sacrum and thoraco-lumbar junction that would interfere with the full expansion of her uterus during pregnancy. We are looking forward to meeting this woman’s third child to confirm the validity of this osteopathic theory.

Usmara treating a baby with sepsis and herpes in Gilgit district hospital

Usmara treating a baby with sepsis and herpes in Gilgit district hospital

Before reaching Nagar, we had spent two days in Gilgit, hosted by our generous friend dr. Wajahat, a pediatrician we have known and worked with since 2008. Dr. Wajahat works tirelessly to respond to the immense needs of the population of this growing city in the mountains. He invited us to treat patients under his care who were not getting better at the local district hospital. Usmara treated a baby with sepsis who was not responding to antibiotics, Haider treated a patient with pneumonia and I treated a toddler with unexplained hemiparesis (sudden weakness of one side of her body) following an epileptic fit: they all improved and could be discharged after their osteopathic treatments, their nervous systems balanced, their self-healing mechanisms now better able to maintain homeostasis. I was given to treat a severe case of cerebral palsy who had decompensated after being given the wrong medication: this patient, as I had expected, didn’t get better, as his system was too severely affected.

Our visit to this hospital also offered me the pleasure of becoming the witness to Haider and Usmara explaining osteopathy in Urdu to the hospital administrators. Osteopathy is theirs to share now.

Dr. Wajahat shared many stories of how daily corruption at all levels affects physicians’ work, starting with clean-water plants that exist but are not functioning or not manned properly, bringing thousands of kids to the hospitals with diarrhea every year. Physicians are then asked to treat diseases that could be prevented. He also shared how poor people, while having so little cash, spend it on cheap packaged food to feed their children, aggravating issues of malnutrition. This is an education issue, as their traditional meals of dal, vegetables and chapatis (bread) or rice are as cheap or cheaper, and very nutritious.

Fathers as often as mothers bring their children for treatment

Fathers as often as mothers bring their children for treatment

We also treated a variety of patients at Sehat Foundation Hospital, and in private homes, always with the purpose of helping patients and exposing people and healthcare professionals to the full potential of osteopathy. Some patients from previous years managed to find us, like this woman who was finally able to conceive after her treatment 6 years ago. The Agha Khan Hospital, where we had worked 2 years ago, thanks to Dr. Nadir Shah, had now moved to the outskirts of the city.  We visited the beautiful new grounds and modern facilities and had time to treat only some of the staff. We will organize proper osteopathic clinics for a day or two for our next visit in 2017.

Usually we spend a week in Lahore working in hospitals. Because there were no foreign volunteers and Haider and Usmara had a deadline to finish writing their osteopathic thesis for SICO, I concentrated on meeting and treating people who could help the creation of the future osteopathic school in Pakistan. Aleema Khan, OWB’s board member in Lahore, was extremely resourceful and effective as a networker and strategist. We are making progress, slowly but surely.

OWB team in Lahore, with Aleema Khan

OWB team in Lahore, with Aleema Khan

On my last day in Lahore, with Haider and Usmara, we had the pleasure of presenting osteopathy to faculty and masters students in physiotherapy at Riphah University.  We started with a short powerpoint presentation and then treated a patient as a demonstration. She was a 29-year old woman presenting complaints of headaches, neck pain, low back pain and dizziness, not responding to physiotherapy for the last 6 months. While I examined and treated her, I could explain to the engaged audience the thinking, principles and practice of osteopathy, a medicine that uses gentle manual techniques to create a dialogue with the self-healing mechanism of the patient, that looks for the causes of dysfunctions in the entire body and normalizes the structure in order to improve function. The philosophy of osteopathy was validated by the immediate response to the treatment: pain was decreased, mobility was increased.  The patient’s treating physical therapist could even show us a before and after video of her opening her mouth: they had failed to tell me that dysfunction was another symptom she suffered from, and without targeting it specifically, the treatment resolved it because once the structure is aligned, the body self-heals all of the interconnected systems.  The videos are on our Facebook page.

The program we are looking to introduce to Pakistan is the 5-year full-time program for graduates of grade 12.  Initially, professors from the CEO in Montreal will be traveling to Lahore for the osteopathic courses, while the basic sciences courses will be taught by local professors. Haider and Usmara will be first assistant-teachers and will take over teaching responsibilities as their experience increases.  This program will also be available to health-care professionals as a part-time program.

If you are interested and able to support our vision of an integrative health-care system in Pakistan, that will allow more efficient distribution of resources and improve health and well-being in the population, please contact us.  We can only succeed as a team.

Thank you,

Sylvie Erb
Osteopathy Without Borders

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