2023 Osteopathy Without Borders’ Mission to Rwanda

2023 saw a new chapter open for Osteopathy Without Borders, with a mission being organized in Rwanda. It was initiated by Robin Breger DO, a graduate of the CEO in Montreal, who worked in private practice for 3 years in Kigali. During that time, she developed enthusiastic interest and following for osteopathy, both in patients and health care professionals, which drove her to seek to build on that momentum.
Osteopathy Without Borders was created in 2007 to promote awareness of osteopathy in developing countries through humanitarian missions and to promote the transfer of skills in order to improve health-care systems with this low-tech, effective holistic medicine.

This endeavor reflects a collaborative effort and financial participation of multiple institutions including Osteopathy Without Borders (OWB), Rwanda Physical Therapy Organization (RPTO), University of Rwanda (UR), Africa Rising Cycling Centre (ARCC), Ishobe Rwanda wellness retreat and the Bugesera Lodge, all with a shared interest of bringing osteopathy to Rwanda.

The mission began on Friday November 10th 2023 when the volunteers departed their countries of origin to travel to Kigali, Rwanda. Faisal Naqvi DO departed from Montreal, Canada while Dr. Christine Bauer MD, DO and Heidi Gaissmaier DO departed from Munich, Germany.
Upon arrival they were met by Jean-Damascene Bigimirana Ngamba, Physiotherapist, CEO of HealthEdu Ltd and Community Manager of Jamk Rehabilitation in Rwanda along with Peter Kaberuka, Physiotherapist who had worked in collaboration with Robin Breger while she was in Rwanda.
Throughout the mission in Rwanda, Peter took the team around and tended to all their needs and logistics sacrificing time with his family and patients for the needs of the mission. Osteopathy in Rwanda owes a great debt of gratitude to Peter Kaberuka!

On their first day in Kigali, the volunteers visited the Kigali Genocide Memorial to pay respects to the history of Rwanda before meeting with some locals, including Steffi Mushayija, a Physiotherapist who moved to Rwanda from Belgium, and who hosted the team at her residence for lunch on a couple of occasions during the mission. Steffi had previously worked with Osteopaths in Europe and was excited to continue that collaboration in Rwanda as she had done so briefly with Robin Breger and continued to do so by referring multiple patients to the team during their mission.
One of the main purposes of the mission was giving the first “Introduction to Osteopathy” course ever in Africa. This course took place on the 14th and 15th of November, 2023 at the University of Rwanda – College of Medicine & Health Sciences (UR-CMHS), where health professionals received instruction on the basics of Osteopathy. OWB hosted a group of 16 intelligent and motivated Rwandan participants who learned about the history, principles, concepts and techniques of Osteopathy.

Following the 2 day course, there was a day of rest when the visiting osteopaths toured Kigali and visited Seeing Hands which is an institute founded and run by Ms. Beth Gatonye who is a Massage Therapist (seeinghandsRwanda.org). Seeing Hands teaches and employs blind people and trains them in massage so they can earn a living and support themselves.

Seeing Hands generously offered massages for the osteopaths who in turn treated some of their staff. The exchange proved to be very rich and beneficial for everyone.

The next 2 days were reserved for treatment at the University of Rwanda Polyclinic where the group treated patients coming from referrals from Robin Breger, Peter Kaberuka and their respective networks. These days of treatment were made possible by the coordination of Peter who oversaw the scheduling between patients and observers who were from amongst the participants of the course given a couple of days earlier.
Amongst the patients who were treated were family and friends of the course participants, Robin’s patients and network as well as staff from the polyclinic.

At the conclusion of the second day of treatments the team departed Kigali and drove to Kaninya in the evening to meet with Chantal Umuraza Esi, founder of Ishobe Rwanda, a wellness retreat center that hosted the team for 2 nights. While at the retreat, the team treated villagers from Kaninya, students from the local schools, staff and others who travelled from Kigali for treatment.

On the Sunday, the team travelled to Musanze which was a 2-hour drive through the mountains, in the rain, to arrive at the Africa Rising Cycling Centre (ARCC), the main training center for Rwanda’s national cycling team that also offers cycling and cultural experiences for tourists. The team was met by the administration of the ARCC and some of their top athletes.
The Osteopaths treated a few of the cyclists and members of the administrative team then took advantage of the surroundings and went for a walkabout through the village which is set to the backdrop of volcanoes.
The team seized many opportunities to meet and mingle with the locals. It is amazing to see how universally welcoming people can be, especially when a person embarks on humanitarian work. The people of Rwanda were consistently friendly, welcoming and curious when it came to visitors to their region (Muzungus).

The next day had the Osteopaths treating more cyclists who arrived at the centre for treatment to help with injuries and performance. Some cyclists came from over 4 hours bike ride away to see the Osteopaths for treatment. It is not uncommon for the cyclists to have regular crashes during competition for which they rarely have the chance to get re-aligned and mobilized properly as was finally done by the Osteopaths.
At the conclusion of the final day at the ARCC the team took advantage of the setting and headed out for a mountain biking tour of Musanze, led by Abed the cycling team therapist on the centre’s top mountain bikes. It was another great opportunity to meet and interact with the locals on the hills of Rwanda.

Upon return to Kigali there were a series of meetings setup for networking and to plan the remainder of the team’s time in Rwanda. Most notable, was a meeting with Dr. Nuhu Assuman who is a Senior Lecturer and Deputy Dean of the School of Health Sciences, College of Medicine and Health Sciences at the University of Rwanda. Dr Nuhu met with the team for dinner despite coordinating the first ever Rwandan Rehabilitation Conference that was set to begin the next day!

On the second Thursday, the team treated patients at Peter’s clinic who were referred from the first week’s patients. Among the variety of people were more victims of genocide and its lasting aftereffects along with more frequently seen cases of aches and pains. At the end of the day the team departed Kigali for Bugesera to be hosted very generously by Ms. Jocelyne Mulera at the Bugesera Lodge and offered a full day of treatments to community members there.

On the last day in Kigali there were a couple of last minute treatments that got scheduled for people who tried to connect with the team during the mission which had not worked out.

The final activity before heading to the airport was a wonderful dinner hosted by Peter at his home for all the people who had participated and contributed to the success of the mission.

In summary, the first ever Osteopathy Without Borders’ humanitarian mission to Rwanda was a great success in regard to the number of people who were treated and exposed to osteopathy, the teaching of the first “Introduction to Osteopathy” course along with many other benefits linked to the trip.

We look forward to taking the next steps with our international and local partners towards bringing Osteopathy to Rwanda!

A Case Study – trauma from the 1994 genocide:

Sandrine was born in 1985.
Both her parents were killed by a machete attack in front of her. She was rescued by her parents’ neighbor who treated her for her own machete attack injuries then moved her for rescue in exile to RDC Congo. During her period in exile, the refugee camp discovered she is Tutsi and their organization tried again to kill her; she was only 9 years old!
She escaped from the RDC Congo with the help of the Red Cross who brought her back to Kigali. After 10 years she heard that her two siblings were still alive meaning that one sibling was killed with the parents while 3 survived.

She endeavoured to find her siblings and brought them to live with her. As the oldest, she started parenting at age of 19 years old.
She insured that her younger siblings first got married then she got married herself.

Leading up to her wedding, she got hit by a motorcycle one week before wedding that required one year to recover from!
She is now married and has two kids.

Sandrine was the only patient who I treated twice during this mission. She had visible scars on her face, head and neck from being attacked by machete at 9 years old. Her complaints were: constant headache at left temple from where she got hacked by machete, dry eye on the left side, emotional instability, anxiety, neck pain, irregular menses.

The first treatment included treating locally her scars after which she said she felt tingling and throbbing in the 29-year-old scars.

The second treatment had her trusting more in the effects of osteopathic treatment. During the session we used the physical body to access the mental and spiritual trauma imbedded in the scar tissues. This led to Sandrine releasing deeply ingrained emotions and crying profoundly as the tensions were released.

She was also experiencing profound fatigue which was causing her to yawn excessively during the treatment to the point that she dislocated her jaw! We proceeded to reduce her jaw and realign the bones which allowed her to continue releasing the associated emotions.
I kept her mindset balanced guiding her towards levity which had her intermix laughing with her crying which permitted her to go even deeper into her sorrow!

Once the treatment was complete, she was smiling and even dancing in a way she had not done for decades!
Balancing a person’s physical, mental and spiritual health is essential to help a person move on from previous traumas. This is something osteopathy does uniquely well and that can benefit Rwandans significantly given their past, including the genocide.

Special thanks:

This mission couldn’t have happened without the generous support of the following individuals:
Our team in Rwanda: Peter Kaberuka, Jean Damascene Bigimirana Ngamba, Dr. Nuhu Assuman
Donations by:

1. Chirag Daswani
2. Marijcke Van Overberghe
3. Freya Zaninka Declerck
4. Violaine Faye
5. Jocelyne Mulera, https://www.bugeseralodge.com/
6. Chantal Umuraza Esi, https://www.instagram.com/ishoberwanda/
7. Africa Rising Cycling Center, https://arcc.rw/
8. Steffi Mushayija
9. Vanessa Alinejad
10. Aida Yassine
11. Beth Gatonye, https://seeinghandsrwanda.org/
12. Beata Gorecka
13. Teta Ndejuru
14. Jennie Ekedahl
15. Betty & Laurie Breger, Chuck Breger & Mariam Bowen, Robin Breger

Osteopathy Without Borders was created in 2007 to bring the profession of osteopathy to developing countries, starting with Pakistan. We funded the training of two osteopaths in Lahore, who are now ready to be part of our second phase: the creation of an osteopathic teaching program at Khyber Medical University (KMU), in Peshawar, Pakistan.

Those who have followed us for some time know we were hoping to start the first osteopathic school of Asia at Khyber Medical University (KMU) in Peshawar this fall.  Because of time constraints this past year at our mainschool in Montreal, the College of Osteopathic Studies (CEO, College d’Etudes Osteopathiques), we have had to postpone by one year, and so we organized a two-week mission again, in Lahore and Peshawar this past October.

The core leaders of OWB, Sylvie Erb, DO and Faisal Naqvi, DO, were lucky to be accompanied by two volunteers from Montreal, Paula Gonzalez and Marie Phaneuf-Tibault, recent graduates of the full-time program — the same that we are bringing to KMU in Peshawar.  We started the mission in Lahore, where we met the first two osteopaths of Pakistan, Usmara Zafar, DO and Haider Ali, DO. 

Over the last few years, we’ve organized several “Introduction to Osteopathy” workshops, led by Faisal Naqvi, DO, to present this new medicine to physiotherapists and physiotherapy students. Because of the enthusiastic response, we decided to organize a part 2 to this workshop, so that physiotherapists could get more tools to help their patients and a deeper understanding of the specificity of osteopathic principles.  We very much enjoyed being able to welcome those participants at our Osteopathy Center in Lahore. This workshop was very successful and we hope to find some of these students in a future class of osteopathy at KMU.

To satisfy the requests of many who had not yet attended an “introduction to osteopathy” workshop, we added a one-day workshop for them before leaving Lahore for Peshawar.

We started our work there with the third “Osteopathy Camp at RMI”.  Rehman Medical Institute was keen to welcome osteopathy as soon as they heard about it, and we thank their CEO, Shafique Ur Rehman, as well as their physiotherapy team led by Dr. Muhammad Bin Asfar Jan, for their wonderful hospitality and support. Because it was our third camp, the word had now gone around and, like happens everywhere for osteopathy, there were many more requests than time slots available. We treated young and old, with both musculoskeletal and internal medicine diagnoses. We treated people and not symptoms, releasing the causes of dysfunctions to insure better health for the long term.  

One case stood out for me: an older man came with one single complaint: severe pain in his left upper trapezius, the muscle between the neck and shoulder. His posture showed a severe deviation of his thorax to the left, with an elevated shoulder. What was remarkable with this man was that he was exceptionally healthy, and his structure was moving well, including his cranium, a rare finding among our patients.  There was only one area of significant tightness: his pericardium, the solid fascia that surrounds the heart and is attached to ribs and vertebras. We spent the entire session just working on releasing imprints of trauma in the pericardium and integrating the changes in the surrounding tissues. Sure enough, when Usmara asked whether there had been an emotionally traumatic event in his life, the old man shed a tear for his young daughter who died years ago. The feeling of a broken heart that had become solidified in his body but was now ready to be released. He left with an alignment close to normal and great relief.

Thanks to our partner at KMU, Prof. Haider Darain, we were connected with a new organization this year, Northwest General, School of Medicine and Hospital. Dr. Danish Ali Khan, assistant director, had organized a presentation to the medical school faculty and physiotherapy students that was followed by a workshop for the students. It was an opportunity for our two volunteers to tell their stories of how and why they chose osteopathy.

Paula used to be a biologist, having loved to study life. When the time came to go back to work after raising her children, she wanted to work with life within people rather than behind a microscope. Osteopathy offered the most direct access to witnessing the magic of life within a person. Marie was the lucky recipient of osteopathy treatments when she was in her mother’s womb. Three generations in her family were treated by osteopathy and at age 12 her choice was made: she would become an osteopath.  

Our case stories inspired the participants:  when we did a 2-day osteopathy camp at Northwest a few days later, already there were more patients than available slots. During the workshop, Sylvie treated a young man who had suffered whiplash 2 months earlier, and who was suffering from severe upper back pain for the last month. He reported he tried everything he could find to get relief and nothing worked. It was his lucky day as the single osteopathy treatment in front of the group gave him total relief. He called it a miracle but we made sure to confirm that osteopathy is a skill that can be learned, and will be taught starting next year, Inshallah, at KMU.

We had visited the pediatric ward at RMI last year and now it was time to demonstrate how osteopathy could help such a population. Invited by Prof. Bakhtiar, the team went through every department within Pediatrics, including the neo-natal unit, where preemies were attended to. Some solid research from Italy showed how osteopathy can decrease complications and length of hospital stay in this population.  

In our private practice, when we treat patients who suffered from meningitis or encephalitis in the past, we find their dura-mater to be extremely tense. We had the opportunity to treat such patients right there in the ICU, when they were struggling with the infections, enabling better recovery. Physicians were impressed by the unexpected recovery of a young girl suffering from encephalitis who was in a coma.  We also treated a number of children hospitalized for enteric fevers or pneumonia. We all regretted not having more time to follow up with those young patients who stand to benefit tremendously from osteopathy.

Other than treating patients, our priority was to inform college and high-school students of the coming program at KMU, which will allow them to become osteopaths. To that effect we made presentations at two colleges, thanks to the facilitation by Dr. Danish.

The one-year delay for the start of the first school of osteopathy of Asia gives us one more year to collect the funds we’ll need to run the project. Thank you for your help transferring the art and science of osteopathy to Pakistan, which will enable to creation of a modern, integrative, effective, healthcare system.  

With gratitude,

Sylvie Erb, PT, DO(Q)

Director

Osteopathy Without Borders

Our mission this past Summer saw the signing of a Memorandum of Understanding (MOU) between the CEO (College d’Etudes Osteopathiques in Montreal) and KMU (Khyber Medical University in Peshawar) to start the first osteopathic school in Asia at Khyber. After 11 years of annual humanitarian missions exposing the benefits of osteopathy to medical professionals, public health executives and the general population, we are happy to partner with the Institute for Physical Medicine and Rehabilitation (IPMR) at KMU in Peshawar.

Philippe Druelle, President of the CEO, signing the MOU in Montreal in June.

Prof. Arshad Javaid, Vice Chancellor at KMU, signing the MOU in Islamabad in July.

The planned full-time osteopathy program will be part of IPMR, under the direction of Dr. Haider Darain, who, since we met him last November, has already been an invaluable partner and supporter of osteopathy.  The Montreal school’s 5-year program respects the highest standards described by WHO in its Benchmark Papers. There will be an option for healthcare professionals to enroll as part-timers.

Faisal Naqvi, DO, during the workshop at KMU.

The MOU was signed in June in Montreal by Philippe Druelle, DO, Founder and President of the CEO, during the CEO’s year-end gala, and in July in Islamabad by Dr. Arshad Javaid, Vice Chancellor at KMU. With this project, both leaders and their teams are committed to bringing modern, cost effective integrative care to Pakistan. Because they can cure or help to restore health to a wide range of patients with only their hands and hearts, osteopaths, once the profession is recognized by the government, can easily work in rural areas or large hospitals, in neighborhood schools or private clinics, without medication or technology. KMU being a government university, they will make sure the profession becomes official in KP province and then in the country. 

We want to thank here our board member Aleema Khan, who made the first introductions between KMU and OWB, and who has made sure over the years that all in her family received osteopathy. From the early days in 2007, her insights, strategic thinking and commitment to providing care and opportunities for all have been guiding forces to our efforts. 

Aleema’s brother Imran Khan was elected Prime Minister at the beginning of our mission. Osteopathy fits well with his agenda of providing more opportunities and better care to the people.

Following his first trip to KMU last November, Faisal Naqvi, DO, gave another “Introduction to Osteopathy” workshop at IPMR to a group of faculty, physiotherapists and finishing students. The first two osteopaths of Pakistan, Haider Ali, DO and Usmara Zafar,DO, from Lahore, were of course part of the mission. It was interesting to hear some students who attended the November workshop report on their successes or challenges with the techniques they had learned. Because we ended up staying in Peshawar for 10 days, we got to hear of their further progress with their patients following the workshop. The beauty of the 5-year part-time program for physiotherapists or healthcare professionals is that the techniques learned during each 5-6-day module can be used immediately with one’s patients with great results.

Our team meeting with Dr. Haider Darain, head of IPMR at KMU.

Thanks to Dr. Haider Darain, we were introduced to Rehman Medical Institute (RMI), a private hospital and medical school in Peshawar. Mr. Shafique Rehman, its CEO, always on the lookout for ways to improve their services, was very interested to experience what osteopathy could add to patient care. I was invited to make a presentation to their doctors, physiotherapists and students while Faisal continued with an afternoon workshop. A second day was dedicated to demonstrations with the physiotherapy patients (and staff).  It was an opportunity to showcase osteopathy’s specific way of treating patients suffering from back or joint pain, stroke or brain injury. The staff was quite enthusiastic to discover a new resource to help further improvement for their patients, and for themselves as patients. They wanted more.

Faisal Naqvi teaching at RMI.

Our team with Mr. Shafique Rehman, CEO at RMI, and Dr. Muhammad Bin Afsar Jan, head of the physiotherapy department.

Mr. Shafique Rehman, a fast thinker, and a generous and dedicated leader, brought up the idea of osteopathy camps at RMI, co-sponsored by KMU. We will be sending small teams of osteopaths a few times this coming year to create more awareness of this new profession coming to Pakistan. The first one of these week-long camps will happen in October.

Our team presenting osteopathy to the staff at Dost Welfare Foundation.

Faisal Naqvi explaining the osteopathic treatment to psychologists at Dost.

Thanks to Aleema Khan, we were also introduced to Dost Welfare Foundation, founded by Dr. Parveen Azam Khan. Dost has a variety of programs to help the neediest in the area. We visited and spent two days at their facility dedicated to helping drug-addicted children. Their program includes a 90-day residential rehabilitation program, using psychology and counseling, art and theater, education and skill building, and no replacement drugs.  Illicit drugs are typically used to relieve pain, whether physical or emotional, and osteopathy can be a very effective resource to decrease pain. The general feedback was that one session was not enough to bring about significant changes in children who have a very complicated and traumatic history. Here is an example of an institution that would do well with an osteopath on staff.

Faisal and Haider surrounded by physiotherapists and students interested in osteopathy at Gulab Devi hospital.

Demonstration at our Osteopathy Center in Lahore.

We made our way back to Lahore to meet with the physiotherapists and students who attended our workshops last year. We spent a day of demonstrations at Gulab Devi Hospital and one day at our own Osteopathy Center.  We had about 30 attendees at Gulab Devi and 10 at our Osteopathy Center, including several who were ready to sign up for the program.

The home for the first Osteopathy School in Asia, at KMU, Peshawar, Pakistan.

If we have a large enough number of candidates for the part-time program, we will start a specific class for healthcare professional in the Fall of 2019, so please confirm your interest if you are not yet on our list.

The key commitment of OWB and the CEO school in Montreal is to provide the highest level of training to the future students of osteopathy at KMU in Pakistan. To this end, experienced professors will travel from Montreal to teach. This extra cost will require the participation of all of the supporters of osteopathy, as we will be raising funds to pay for scholarships so that the cost to the students is affordable.   We thank you for your generosity if you are able to help with our goal of a healthier healthcare system in the new Pakistan.

Sylvie Erb

We started the mission this year with a bang: an “Introduction to Osteopathy” course that attracted 60 attendees, physiotherapists and physiotherapy students.

Haider Ali, DO, assisting teaching

The high attendance surprised us. For the last ten years, several pioneers embraced our vision of a healthier healthcare system, where osteopathy would be available in all neighborhoods and rural areas as a first line of care, and as complementary care in hospitals or within physician practices. But we had received little interest from healthcare professionals. It meant a commitment of too much time and money for training in a profession that meant nothing to them.

But now, after ten years of effort, and the passage of time, things have changed and now osteopathy is known and talked about, thanks in part to the beautiful work by the two Pakistani osteopaths we trained, Haider Ali, DO, and Usmara Zafar, DO. They have built a solid reputation in Lahore. It’s also because osteopathy is one of the fastest growing medical professions in Australia and other Western countries.

The charismatic professor in our group, Faisal Naqvi, DO, from Montreal, Canada, who was part of the first mission, and has come with us 6 times in 11 years, transformed the opportunity into a success: the attendees were very impressed by the effectiveness of the techniques they were taught.  Many comments on the feedback questionnaires asked for osteopathy to be in every clinic, hospital or neighborhood. They loved that it had such immediate results in the mobility of the tissues, using no force, just a dialogue with the living tissues. Some students were so impressed they asked for us to meet with the executives of their universities to talk about their hosting the osteopathic school we want to bring to Pakistan. We are very grateful to these visionaries for the opportunities offered and are working towards opening a part-time program of osteopathy in early 2018, open to healthcare professionals. When there are enough local osteopaths, we’ll be able to start a full-time Masters in Osteopathy program with our partner university. Inshallah!

The proud class after 2 days of learning to listen to the tissues, feeling balance points and still points and immediate releases.

Usmara Zafar, DO

We ended the mission with another bang: the inauguration of the Osteopathy Center at Namal Education Foundation (NEF), in New Garden Town, Lahore. Aleema Khan, board member at OWB and NEF, is used to thinking big and achieving great results. She had the vision of a dedicated space for the Osteopathy Project in Pakistan, that would serve as a hub for OWB’s activities: a part-time clinic for our two local osteopaths Haider and Usmara, a place where foreign osteopaths and volunteers can treat private patients and also, once there are local students, a place where clinical demonstrations can take place.

The treatment room at the new Osteopathy Center.

Usmara Zafar taking her turn addressing osteopathy supporters during the inauguration of the Osteopathy Center.

In the name of Namal Education Foundation, Aleema Khan distributed awards to each volunteer for their work bringing osteopathy to Pakistan, here with Mr. Sikander Mustafa, NEF, and Mian Masood, VC of South Asia University.

Aleema and her team at NEF designed beautiful panels telling the stories of the 11 missions since 2007. It made Faisal Naqvi and I quite nostalgic, and also very grateful for all that was accomplished during those years. We were very pleased to welcome some early supporters of osteopathy in Pakistan: Dr. Pervaiz Iqbal, orthopedic surgeon at Sheik Zayed Hospital, who first opened the doors of a hospital to the missions. Shahima Rehman, chairperson of Fatima Memorial Hospital, who allowed a study to be conducted at their community center, showing the significant improvement in general health of 50 patients treated with osteopathy for neck or back pain. We were pleased to welcome the Vice-Chancellor of University of South Asia, Mian Imran Masood, and his group of executives and professors, who were first introduced to osteopathy during this year’s course and who are interested in helping in our mission.  Many patients came showing their support for a medicine they have come to depend on for their health and well-being, as well as a solid group of “future osteopathic students” (as the tags distributed to them at the entrance said) who came to learn more about this osteopathy they were becoming passionate about.

Faisal Naqvi, DO, read the address by Philippe Druelle, DO, founder and director of the CEO.

After a reading of the Koran, each of the osteopaths present took a turn at the lectern, talking about the history of the missions and sharing their vision of a healthier healthcare system in Pakistan, where osteopathy is integrated at an early stage of development, allowing better allocation of tight financial resources to improve the population’s health. Philippe Druelle, DO, founder and director of the College d’Etudes Osteopathiques (CEO, college of osteopathic studies), in Montreal, sent a heartfelt letter for the occasion that thanked all our friends who supported our efforts so far, and promising his and the CEO’s teachers’ full support for the creation of the future school. This first osteopathic school of Asia will provide the highest quality of training, fitting international standards, by initially sending professors from Montreal.

Our time in between those two great successes was very eventful. We are used to going to work in Nagar and Gilgit, in the Northern mountainous areas, to demonstrate how osteopathy can be a valuable help in rural areas.

As we started our journey, we learned that our guide Ibrahim, because of whom we were working in Nagar, had suddenly died the day before. We used to call Ibrahim an honorary osteopath, as he was such a dedicated advocate of our medicine. He was working selflessly to bring development to his remote valley and had helped organize our work, in the schools (he was a teacher) with his cousin Imdad Hussain, a school principal, and in different neighborhoods. He was instrumental in helping us convince mothers to stop flattening the head of babies for beauty, as he had witnessed and understood the harm caused by that compression of the cranial base, irritating precious nerves and weakening the health of the children. He’ll be greatly missed by us and all in Nagar valley.

We had to leave our favorite clinic in the mountains of Nagar….

Despite their grief, our friends Imdad Hussain and Khairullah Nagri organized our first day of work at our favorite clinic: the grounds of the local palace. It is very special for osteopaths to work outdoors under the trees, surrounded by powerful and still mountains. Unfortunately, that first day became our last: the police came and told us to leave because we didn’t have the proper authorizations. I won’t go any further into that story. Suffice to say it was heart-breaking for all of us. This order applied for the whole province, which meant that when we met with Dr. Wajahat, a very generous and dedicated pediatrician in Gilgit, also an early supporter of our efforts since 2007, we were not able to work with him in his two hospitals as planned. In the privacy of his house, we did take the opportunity to treat the baby that was brought to him because of yet another febrile fit, after five days of medication. Every mission, Dr. Wajahat has enjoyed being able to offer further care for those among his patients not responding to his treatments. Releasing the flow of circulation allows the immune system, or the antibiotics if necessary, to flood the infected area in order for the healing to be complete.

All of us at Osteopathy Without Borders and our friends in Nagar and Gilgit feel we have invested a lot during those 11 years of missions, where now osteopathy is appreciated and wanted. We trust osteopathy will be back, we hope next with Pakistani osteopathic students accompanying western volunteers.

…. and found a hospitable hospital in the cool hills of Nathia Gali.

In the meantime, we had to come up with alternate plans to offer our services to patients who could benefit. We ended up working 3 days in Islamabad, a city we had transited through but never had time to work at before. We met many influential and supportive people who recognized the value of our vision and promised to help.

Two years ago, when I was not granted a visa, the team worked in Nathia Gali, a small resort town in the cool mountains, 2.5 hours drive from Islamabad. The schools where the team had worked were not in session, so we connected with the head of the local government outpatient hospital, Dr. Wahid Zaman Khan. He shared a lot of horror stories with us about the state of the hospital he found when he was posted there 12 years ago. The filth and decrepitude of the place couldn’t have it deserve to keep its name of a hospital. With huge effort and vision, Dr. Wahid has transformed the hospital into a very pleasant, welcoming and safe place for 100 to 200 patients coming through every day.

The cool hills of Nathia Gali, where Pakistanis find refuge from the Summer heat.

The 3 of us volunteers set up our osteopathic clinic in a ward and Dr. Wahid wrote his first prescriptions for osteopathic treatments, in a collaboration that we hope to see repeated in every clinic and hospital in the future. As always, we asked to treat children as a priority as they respond best to the one treatment we are able to give.  We treated a number of children with a wide range of issues: leg and back pains, blocked nostrils, headaches, poor appetite for the bigger children, poor head control for a 7 month old. Marie-Claude Laroche, DO, a volunteer from Montreal, treated a 6-year old who was complaining of pain after a fall. Nothing was broken so there was not much the doctor could do. He responded very well to osteopathy and the severe asymmetry of his thorax and shoulders were corrected, insuring he would heal without sequelae.

Dr. Wahid Zaman Khan.

We also treated a few adults and one in particular was blessed by our visit that day. A 40 year old man was complaining of severe leg cramps and pain, bladder issues, headaches, abdominal and back pain, chest tightness, recent development of diabetes, a history of hepatitis. He reported having spent a lot of money already for treatments that had not helped at all. His face showed severe pain through the first half of the treatment. He relaxed, and his back felt better when he left after the double treatment I gave him, but he was still very uncomfortable. I found the thoraco-lumbar junction in his back so rigid and misaligned, it felt it had been broken. The nerves emerging from this section of the spine control the kidneys, that felt empty, as if there wasn’t enough perfusion to them. His chest was very tight, as were his cranium and sacrum, interfering with his body’s ability to heal naturally. I spent so much time with him because clearly medication was not going to support his healing when the cause of his discomfort was so predominantly mechanical. During a phone call the following day, Dr. Wahid reported that the patient had come to the hospital to thank him as he was feeling so much better. He was praying for all of us. How much misery and money could have been saved if this man had had access to osteopathy earlier?!  This is why we are committed to our mission of creating so many osteopaths that they are in every clinic and hospital, in every neighborhood, providing greater health for less cost to the general population.

During our time in Lahore we split the team in two. I went with Haider and Usmara to meet with executives at several universities who are interested in partnering with our school, the College of Osteopathic Studies in Montreal, (CEO, College d’Etudes Osteopathiques) to start a part-time program open to healthcare professionals, starting early 2018.  Faisal and Marie-Claude connected with the students of the workshops at their different hospitals and did demonstrations with real patients. One demonstration at Gulam Devi Hospital was particularly extraordinary. The patient was a 70-year old man complaining of leg pain, which interfered with squatting (indispensable in their environment) and restrictions at the shoulders and arms. The 15 physiotherapists and physiotherapy students watching were able to witness a full resolution of this man’s symptoms. It was so immediate and impressive that they broke into an applause while the patient cried and blessed Faisal and all.

These highlighted success stories don’t happen with every patient of course, but most patients leave an osteopathic session with increased ability to create health autonomously, which allows them to come closer to fulfill their potential. Osteopathy has grown in the West as practitioners and patients alike appreciate its gentleness and efficiency. Integrative medicine is becoming commonplace in most major medical centers, as science validates the efficacy of complementary medicines. It is our hope that our efforts to bring osteopathic training at this early stage of development in Pakistan will allow the evolution of a healthier healthcare system, where functional issues can be helped or resolved with osteopathy, lightening the burden of physicians who will focus their skills and technology on the more serious or urgent patients.

We have started a list of interested healthcare professionals ready to commit to the 5-year part-time program. If we get 30 of them, we can start the program in early 2018, Inshallah!.  Professors will travel from Montreal, Canada, to ensure the highest level of training, while Haider and Usmara will serve as assistant-professors.  The funds collected through Osteopathy Without Borders will serve to provide scholarships to students unable to cover the high cost of Western teaching. Thank you for your help and support.

Sylvie Erb
Director
Osteopathy Without Borders

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.

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

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

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

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

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

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

Introduction:

Public health leaders all over the world struggle with limited budgets and expanding health-care costs. In Western countries, allopathic care costs are rising exponentially, while in developing countries, access is limited.  Large cities have well equipped university or private hospitals but the rural areas or poor neighborhoods are providing care with basic health units that are limited in terms of services they can provide. WHO says that in developing countries, where more than one-third of the population lacks access to essential medicines, the provision of safe and effective traditional or complementary and alternative medicine (TM/CAM) therapies could become a critical tool to increase access to healthcare.  Ideally, countries would blend traditional and conventional ways of providing care in ways that make the most of the best features of each system and allow each to compensate for weaknesses in the other.

Osteopathy is growing everywhere. It is the fastest growing health profession in Australia and the USA.  It is well established in Europe and Canada. Osteopathy has grown from the base, mostly because of practitioners wanting more effective modalities and patients enthusiastically embracing them. Most osteopathic practice in Western countries is in private practice, although the situation in the USA is harder to evaluate as osteopathic physicians mostly work as allopathic physicians with little place in the current health-care system for manual practice.

The Osteopathic International Alliance (OIA) published a report “Osteopathy and Osteopathic Medicine, A Global View of Practice, Patients, Education and the Contribution to Healthcare Delivery” that reviews published research, including meta-analysis, showing positive results of osteopathy for a variety of diagnosis, most commonly for musculoskeletal disorders (back and neck pain, headaches), but also for functional internal medicine disorders (breathing disorders, pregnancy issues, otitis media, menstrual problems, digestive disorders, disorders of childhood). Unfortunately, most studies are small and do not give a global view of the reach and potential impact of osteopathic treatment. The present study looks to add necessary data to demonstrate the potential benefit of osteopathic care.

Osteopathy looks to restore health by normalizing alignment and mobility to the structure, therefore normalizing weight-bearing on joints but also improving fluid circulation and nerve conduction. All systems being interrelated, the improvement in one system improves the others. Homeostasis, better named homeodynamics, is a normal functioning of the body and every cell is programmed to maintain it. When there is disease, the osteopath looks to the causes of functional dysfunction and releases the mechanical barriers to proper function. That is how patients treated by osteopathy show benefits outside of the system they consulted for. These effects could be called positive side-effects. For example, coming for low back pain and seeing improvement in digestion or sleep. It is clinically experienced, though not yet studied, that osteopathy is a very good preventative medicine, thanks to its possible and wanted effect on circulation and on freeing the ability to maintain homeodynamics, in the same way that tuning your car’s motor with a regular check-up insures better long-term functioning.

The study:

This observational study was performed by the first two osteopaths of Pakistan, Haider Ali and Usmara Zafar, of Lahore, Pakistan. They were trained thanks to the support of the foundation Osteopathy Without Borders. The study measured the changes in subjective health complaints and medication intake before and after 5 weekly osteopathic treatments in patients coming for neck or back pain.

We used a validated health score questionnaire, the Subjective Health Complaints  (SHC) by Eriksen, Ihlebaek and Ursin (Annex 1). The SHC was chosen for accurately describing the health of a person, both physical and mental. Its inventory was found to be a systematic, easy and reliable way to score subjective health complaints and follow the well-being, or lack thereof, in individuals or specific groups of individuals.  Severity of each complaint is rated on a 4-point scale (0 is no issue, 3 is severe pain or dysfunction).  The SHC includes 29 questions, covering pain, flu, neurological, gastro-intestinal and respiratory-allergy issues. Using our clinical experience, we chose to add 3 questions in order to collect data about all body systems, specifically 2 questions for uro-genital issues and 1 question for ENT symptoms. (Appendix 1). To satisfy research protocols, we statistically analyzed the results for the original 29 questions and performed the same analysis for the updated 32 questions questionnaires.  Subscores by systems, as proposed in the initial validating study, were analyzed (flu, pain, pseudo-neurology, gastro-intestinal, respiratory/allergy, with the addition of uro-genital).  The change in the number of medication doses per week was analyzed to provide another perspective on the evolution of health before and after treatment.

The study was conducted at Fatima Memorial Hospital (FMH), Sadman, Lahore, Pakistan. Patients were recruited with the help of Dr. Misbah ul Arfeen, medical director of the Naimshuk health center, between October 2014 and September 2015.  All patients were residents of this low socio-economic neighborhood.

Inclusion criteria were patients of both genders, older than 5, suffering from musculo-skeletal pain and with no significant improvement after 3 months of Standard Care (SC).  Standard care was provided by the community health center and consisted mostly in medication prescription. All patients were used as their own controls as they had been seen by a physician and given SC unsuccessfully prior to being enrolled in the present study.

To avoid confusion as to the causes of changes in SHC scores, exclusion criteria were surgery in the last three months, using steroids, receiving manual or physical therapy in the last two months, and patients unable to communicate well.

There were no adverse effects reported.

Results:

50 patients were included in the study, 33 women, 17 men, with an average age of 42 years.

Chart 1: SHC score results.

The best results, with a p-value <0.0001 were found for all symptoms of pain and headaches, anxiety, sleep problems, tiredness and dizziness.  The improvements were also statistically significant (p value<0.05) for the symptoms of extra-heartbeats, stomach discomfort, heartburn, constipation, breathing difficulties and ENT. All other symptoms improved, although since fewer patients complained of those, they couldn’t reach statistical significance. Only the symptom of heat flushes increased, because one patient reported it as a new symptom at the 2^nd evaluation.

Chart 3: Evolution of total SHC score

Total Subjective Health Complaints (SHC) score showed significant improvement after 5 osteopathic sessions. Analysis was made twice, one for the original validated 29-questions questionnaire and another one for the 29 + 3 questions. P value was <0.0001 in both instances with a mean difference of 9.74 for the 29-question questionnaire (from 17.00 to 7.26).  It went from an average of 17.78 points to 7.52 points for the 32-question questionnaire. A decrease of 10.26 points, p value <0.0001. The range of SHC score at the initial evaluation was 3 to 41 points. It was 1 to 29 points at the 2^nd evaluation.

Chart 4: Subscores results.

This table shows that all 50 patients complained of pain and after treatment only one patient had no pain at all (49 had some level of pain, ranging from 1 to 3). Nonetheless there is significant difference (p value<0.05) in pre- and post- score indicating the severity of pain had decreased significantly in response to the osteopathic treatment. There is a decrease in post scores for all groups however it reaches significant levels for those subscores that had enough patients with those particular symptoms, that is: pain, pseudo-neurology, gastro and allergy (p value<0.05). Flu and urogenital with 4 and 7 patients respectively, didn’t reach statistical significance.

Other variables:

ANOVA analysis were made to see if gender or age affected the quantity of response to the treatment. Results were negative for all variables for general SHC score and each subscore, meaning that the osteopathic treatments helped all population groups equally. Osteopathic treatment was found to be as effective for the complex cases who complained of more than 10 symptoms as for those cases who complain of fewer symptoms. Also, it was found that the duration of symptoms, that ranged from less than 6 months to more than 5 years, didn’t affect the response to the osteopathic treatment. This analysis was done by splitting the symptoms according to duration of <6months, 6-12 months, 1-5 years and more than 5 years.

Chart 5: Medication intake.

Medication intake was calculated on a weekly basis, with a dose of medication taken once a day given a value of 7, twice a day 14, etc…  The change in type of medication, for instance going from Voltaren to Tylenol, was not taken into account. We asked about all medications, not only those to alleviate pain, but didn’t include nutritional supplements. Average intake of medication went from 25.35 doses per week to 9.38, with a p value <0.0001.

Conclusion:

While osteopathy cares to relieve symptoms, its focus is on restoring the body’s ability to self-heal. Because of the basic concept that all of the body systems are interrelated, changes in one system affect the others, positively or negatively.  Osteopathy looks to find the causes of functional dysfunctions, releasing mechanical strains in the tissues that interfere with proper alignment and mobility. Releasing tissue tightness, while relieving pain, also allows normalization of fluid circulation and nerve conduction, which allow proper organ function. An often quoted saying of the founder Andrew Taylor Still, MD, is: “To find health should be the object of the doctor. Anyone can find disease”.  The primary goal of an osteopathic treatment is to restore the body’s ability to maintain health.

This study brings data to the claim that osteopaths make that when treating a patient for one condition, other conditions or symptoms will also improve. We found improvement in all items measured by our questionnaire (except for one patient with a new symptom of heat flushes) whether concerning pain or functional internal medicine issues.  These results, while preliminary, warrant further research into the validity of adding osteopathy to an integrative medical model.  The results of this study are consistent with the number of studies that have measured outcomes of osteopathic treatments for specific diagnosis.  These outcomes are very interesting in themselves, but putting all of those results together is when osteopathy becomes remarkable.

This study calls for more research building on this interesting data, with proper RCTs, adding a third questionnaire and evaluating the cost-savings benefit of providing osteopathic treatments. This would require a coordinated effort between different medical departments and a long-term evaluation but could possibly inform the evolution of a healthy health-care system.

Appendix 1

This year’s mission was a big challenge for all: As leader of the mission, I was not given a visa until 3 days before the return date, which meant I couldn’t go at all.  Although I had applied 2 months ahead, my application got lost in the bureaucracy in Islamabad. An inquiry by the Pakistani secret service was completed before the scheduled date of departure, and still, lengthy procedures prevailed and for no known reason, my visa was so delayed that the mission had to happen without me. What a disappointment for all involved: for me of course, our local osteopaths Haider and Usmara, the unique volunteer from Montreal, who was traveling to Pakistan for the first time, Marc Kafaei, and our friends and supporters in Lahore and Islamabad.

Everyone did the best they could under this unexpected circumstance. Luckily, Haider and Usmara now had sufficient experience of our missions to be able to lead this year’s mission,  which took place in late August-early September.

As an added challenge, because of my visa issue, as a foreigner Marc was not allowed to travel to the the mountain areas, in Gilgit and Nagar, where we usually spend a week. The villagers of Nagar were very sorry to miss the opportunity to have our team provide the osteopathic treatments they have come to expect every year, and we couldn’t build on the precious relationships we had started in the hospitals of Gilgit. We hope to be able to resume our travels there in 2016, but for this year, the mission had to go to plan B.

Thanks to the contacts of our most resourceful hosts in Lahore and Islamabad, Sohail and Aleema Khan, they were able to arrange for the team of 3 to treat in schools in Nathia Gali, 3 hours by car from Islamabad, in a beautiful area of Pakistani Kashmir.  As last year, Abdullah, 14 year-old son of Haider and Usmara, joined the team to serve as translator.

Marc was surprised to see so many children with serious infections. It was an unusually strong rainy season, which certainly challenged everyone’s immune systems.  Osteopathy, by releasing strains in the soft tissues and normalizing nerve conduction to restore balance between the sympathetic and para-sympathetic systems, is very effective in returning the body to its natural ability to self-heal.

After 3 days of work in Kashmir, the team moved on to ISRA University hospital in Islamabad. Dr. Naveed Babur, Principal of the Rehab Department, has been a great supporter of osteopathy since we met in 2013. He invited our colleague Faisal Naqvi, DO, to present osteopathy at their yearly International Rehabilitation Conference. Two years ago, Dr. Babur had also organized presentations to the leading physiotherapists of the city. This was the first time the team worked in their rehab department, demonstrating the difference osteopathy can make to their patients.

During the second week in Lahore, the team visited 3 different hospitals, including Sheik Zayed Hospital, where we first started working back in 2007. Marc had the opportunity to work at Shaukat Khanum Memorial Hospital, a cancer hospital, where the severely sick patients appreciated osteopathy’s gentle touch.

Of course the team returned to Fatima Memorial Hospital, where Haider and Usmara have been working one day a week for more than a year, with their community patients at Naimshuk.

This weekly Osteopathy Day at FMH has served different purposes:

• treat patients from the poor community for free;
• expose doctors and medical staff to osteopathy;
• provide patients for a study Haider and Usmara have completed about the efficiency of osteopathy for neck pain patients.

The results are going to be analyzed 2 different ways. First, a comparison of the results of osteopathic treatment for neck pain by social class, to see if the poor living conditions of the community patients affect the outcome, in one direction or another. That will be the thesis Haider and Usmara will write to obtain their Diploma of Osteopathy at SICO, the Swiss International College of Osteopathy where they have completed their 5-year part-time osteopathic program, thanks to the support of donations to Osteopathy Without Borders.

The second analysis will use the results of a health-score questionnaire that was given before and after those treatments, to measure the impact of osteopathic treatments on general health, what I call the positive side-effects of osteopathy. You can see the preliminary results presented on this next page. They are very encouraging and should help anyone not knowing osteopathy understand the exceptional impact this method can have on community healthcare.

We are still working at bringing an osteopathy program to Pakistan. Hurdles are many, but our team at OWB is dedicated to bringing the gift of osteopathy to those who can greatly benefit from it. Sending Western teachers to Pakistan will be expensive but will ensure the highest quality of training so that the promise of osteopathy can be fulfilled to the professionals and people of Pakistan.

Thank you for your donations to help us realize the vision of a healthier healthcare system.

Osteopathy Without Borders (OWB) was created in 2007 to support training in  osteopathy, a form of low-cost, effective medicine for developing countries. We have started first in Pakistan. Every Summer, a small team of volunteers treats patients in Lahore’s hospitals and in Nagar, a remote mountainous valley, to demonstrate osteopathy’s reach and effectiveness.

OWB team with the physiotherapists at Gurki Hospital.

Two physical therapists from Lahore were funded to study at SICO (Swiss International College of Osteopathy). They finished the part-time training program in 2012 and are now working on their research project in Lahore to obtain a diploma of osteopathy.

This year marked our 8^th annual mission. We were a team of senior osteopaths and volunteers: returning Faisal Naqvi, DO and Sheryl Hoo, DO, from Montreal, and a new volunteer from England, Katy Teasdale, DO, graduate from the European School of Osteopathy (ESO) who has already worked on several international osteopathic missions. You can read her own memoir and see a lot of pictures here.

We arrived on Friday August 15^th, just a day after a march demanding the resignation of the Pakistani Prime Minister started from Lahore to Islamabad.  As has happened many times since we started in 2007, we had to decide whether to go ahead with our mission, despite the political turmoil.  Experience has taught us that unrest is usually localized, and all of the people who are working hard at improving the conditions in their country keep working at it, day after day no matter what happens in politics.  We decided to go and were so glad we did.  Our mission was very productive and gratifying.

Faisal in pediatrics at SZH.

Our priority was to clear the way for an osteopathic school, the ultimate goal of our traveling and treating in Pakistan. Last year we contemplated starting a full-time program, but realized this year, thanks to Prof. Dr. Javaid Asgher, chairman of Lahore Medical and Dental College, that this was not yet realistic.  We returned to our previous idea of a part-time program open to health-care professionals with Bachelors and will continue bringing introductory courses to young physiotherapists and others to pave the way to our first classe in one or two years.

We had hoped to travel to the mountains during our first week in Pakistan, but the weather didn’t allow that. Planes fly only in clear conditions, and with the monsoon season delayed this year, the backlog of passengers made it impossible for us to fly to Gilgit as planned.  Everyone in Pakistan being very adaptable, we switched our plans and worked our first week in Lahore instead. We were happy to return to Fatima Memorial System (FMS), our local partners for the setting up of an osteopathic school.

Shery and Haider working with an orthopedic patient at SZH

Through generous funding from New York and Lahore, Haider Ali and Usmara Haider, our fundees, have worked a day a week at FMH to treat poor patients from Nainshuk, a suburb of Lahore where FMS has a community health center. Thanks to this Osteopathy Day at FMH, doctors have been able to witness Haider and Usmara’s commitment and the efficacy of osteopathy.  Haider and Usmara have produced a pre-study of 30 patients, showing pain scores going from 7.3 to 5.4 to 2.6 (1 to 10 scale) at weeks 2 and 4.   Their thesis protocol is being approved now for research that will study the evolution of general health for patients being treated with osteopathy. Osteopathy’s side-effects are all positive. Whatever the patient comes for, we treat the whole person, which improves alignment and mobility of the whole structure, allowing better physiological functions.  Someone coming for neck pain can see their digestive issues or sleep disorders get better. Another coming for low back pain can see abdominal symptoms disappear etc.

The road to Nagar is long but beautiful.

We were very pleased to have senior physiotherapy students assigned to watch our treatments. Their hunger for learning was refreshing. It was another brilliant initiative by Shahima Rehman, head of this worthy institution, whose commitment to the growth of osteopathy in the country we are very grateful for. We thank all the physicians at FMS for taking time to meet with us and for sending us patients. We look forward to deepening our complementarities to bring better health and well-being to the patients.

Thanks to Dr. Pervaiz Iqbal, orthopedic surgeon and pioneer in all things new and worthy, we could spend a day at Sheik Zayed Hospital, (SZH), a large public hospital that receives a lot of patients from rural areas when treatment has failed in smaller facilities. We concentrated this year on pediatrics and orthopedics.  When the team arrived in the pediatrics ward, a resident recognized us from last year and directed us directly to the chronic ward, remembering we had had good results with those patients.

Flattening of the head affects health and posture.

Thanks to Prof. Javaid Asgher,  we visited the modern Lahore College of Physical Therapy and met its Dean, Hafiz Muhammad Asim, DPT.  At the affiliated Gurki hospital, we worked at the outpatient physiotherapy department, with many interested physiotherapists and students witnessing some very good immediate results of osteopathic treatment.  I worked on babies with development issues, and a baby with torticolis who immediately improved his range of motion. These diagnoses, and most issues of children are commonly treated with osteopathy in the West, as osteopathy is able to release tightness and nerve irritation due to birth traumas.

Last year we were happy to meet Zakir Khan and Dr. Sohail Saleem at the Pakistan Cricket Board (PCB).  PCB players were on tour, but we could treat a few younger players and hope to continue our relationship with the medical support team in order to insure the best performance level of the players.

On Saturday ending our first week, we were very lucky to fly to the mountains. Our group of 7 included the 4 foreign volunteers, plus Haider and Usmara who participated for the first time in this part of the mission, accompanied by their 13-year old son Abdullah, who was assigned the role of English teacher in the Nagar schools we were going to work at.

Baby girl with the flattening bandages around her head. For the last time.

In 2008 we met the late Prince Barkat Ali, Mir of Nagar, who offered us hospitality at his palace for our missions. The palace is a simple, rustic accommodation that recently was upgraded with running hot water, with beautiful lawns, situated on a ridge over the village of Nagar, with tremendous views of Golden Peak, a snowcap peak. We were very lucky this year to be hosted by the young Prince Qasim Ali and his mother Princess Rahat. Prince Qasim is bravely following up with the work his father started before his untimely death 2 years ago. Nagar has a  population of almost 150’000 people, mostly farmers, spread over several valleys, living in rustic and challenging conditions. The views are breathtaking and the air very clean, but development has difficulty reaching this remote valley.

Ibrahim Khan and Imdad Hussain, teacher and principal of private English-language schools, facilitated our working with the children and citizen of Nagar. Their now long experience with osteopathy, their dedication to the improvement of the valley, in health and all aspects, made them wonderful organizers so we could treat very appropriate patients.

This lucky baby girl will have her head return to her normal shape thanks to a timely treatment and the education we provided.

For instance, Haider treated a 13-year old boy with cerebral palsy, a smart kid, who was able to walk, though with stiff ankles and dragging his feet. After the treatment, he was able to walk with more confidence, lifting his feet. Smiling, he said: “I’m very happy, I can walk better”.  Haider also treated an 11 year old girl with vertigo for the last 3.5 years, after a head injury. It was gone after the treatment.

Katy had the joy of seeing her 7-year old patient, who seemed to have had polio, with weak legs and pain and rigidity in his knees, who arrived walking assisted by 2 people, leave her treatment-bed on his own two feet for a few steps. With practice, surely he will make great progress.

I received feedback from Imdad that a 13-year old girl I treated who suffered for 3 years of almost daily episodes of fainting, with episodes lasting 20 to 30 minutes, had had only one 5-minute episode in the following 3 weeks. A boy who had been sent to a hospital in Karachi, at great cost, without relief of his severe abdominal pain that interfered with his normal eating also got relief. All other feedback from our patients at the school were positives. With only one session!

When I first trekked through those mountains, in 2005, with Ibrahim as my guide, I treated his daughter, then a few months old. She was weak and failing to thrive. Ibrahim being an educated man, he immediately understood my explanation that the tradition of flattening the head of babies to make them more beautiful was unfortunately so harmful to the heath of the children, forever. Compression of the nerves exiting the head can weaken the free flow of information, especially serious in the case of the vagus nerves that control the autonomic functions of the organs in the chest and abdomen. We see a lot of cases of headaches, abdominal pain and chronic fevers that resolve quickly after treatments.  As Ibrahim’s daughter became better right after the treatment, they gave up the flattening of her head and I was happy to treat her again now a 9-year old, the healthiest of the siblings, with a beautiful round head.

Gabriel Venne, who volunteered in 2009, designed a poster with drawings showing the harm of flattening the head and we have been distributing those posters every trip. We were very pleased to hear that at least around Ibrahim, children are left with the head nature gave them. Because of the interconnectedness of families in those villages, Ibrahim’s family means dozens of families. Prince Qasim is presiding over the construction of new schools and he and his mother can be instrumental in continuing the education of the population. Once given the information, parents are easily convinced to let go of such a tradition, which only started in the 70’s.

Prince Qasim explains the health benefits of leaving the head round using our poster.

With our goal of triggering some osteopathic careers in the Gilgit area, the main town in the mountains, we returned to Sehat Foundation hospital, invited by Dr. Wajahat Hussain, a very dedicated pediatrician we met back in 2007, and Mr. Zulficar Ali, director. We also were introduced to the Agha Khan Medical Center, thanks to Mr. Sifat Ali and Dr. Nadir Shah. Dr. Nadir being a nutritionist he understood easily the basic concepts of osteopathy, that the body’s natural state is of health and that lifestyle choices determine a lot of the way it behaves. At the clinics we screened patients in the waiting rooms and were able to treat many different types of patients with good success: an 8-month pregnant woman, whose severe pain not only went away but who will now have a better chance of normal delivery, as tension produced by pain would interfere with the progression of the baby down the birth canal. Dr. Nadir got patients’ feed-back later-on who were very pleased with the decrease in pain, whether musculo-skeletal or abdominal, and the general feeling of well-being they experienced.  Some felt they needed more treatments, and they were right, rarely does one session completely resolves a problem, but we are always impressed by how well the population in the rural areas responds. They seem to have a strong constitution and get better faster.

These successes and the enthusiasm of the population, whether patients or public health executives, confirm our strategy of returning to the same villages or institutions over the years. With more manpower, we would be happy to spread our reach, but clearly, only a Pakistani school can make serious progress in providing this wonderful, natural, low-cost medicine to the general population. In Pakistan alone, there are 180 million people. It will take a real long time to create enough osteopaths to help the population recover their good health, and so be able to contribute creativity and energies to the development of their families and country.

If you are a trained osteopath interested in humanitarian work, our contacts in Lahore, Gilgit and Nagar would be happy to receive your services for a few weeks.

If you are a B.H.Sc in Pakistan and motivated to helping your patients reach greater health and well-being naturally while being part of the modernizing of the Pakistani health-care system, please contact us so we can give you more information about how you can become an osteopath.

If you feel inspired to support our efforts financially, we’ll be very grateful, as for the first several years Western teachers will be sent to Lahore to insure the highest level of training. The high cost of training in complementary medicine is the only reason they haven’t spread to the developing countries, where they could help so many. Our effort is to bypass this injustice. Once there are enough local osteopaths, funding won’t be necessary.

Until the school starts, we need funding for Osteopathy Day, where Haider and Usmara will do a study to evaluate the health evolution of their patients treated with osteopathy. This research will add valuable data to the cause of osteopathy, as patients so often report improvement of issues other than the one they consult us for. It will allow public health officials to estimate how much heath is gained with the investment in osteopathic treatments.

We will also need funds to organize introductory courses to osteopathy for physiotherapists and physiotherapy students to pave the way for the school.

The vision is one of a healthier health-care system. Thank you for your support.

Sylvie Erb, PT, DOMP (Q)
Osteopathy Without Borders

Please contact:
In the West Sylvie Erb at sylvieerbosteo@gmail.com
In Pakistan Haider Ali at osteoapthhaiderali@gmail.com