Our seventh mission, this late Summer of 2013, was eventful, and different in many ways.  Unfortunately, in June there was a terrorist incident in the mountain areas where we have worked every year since 2007. After 10 mountaineering tourists were killed, security measures tightened so we were not able to obtain authorization to travel back to Nagar valley. We were very disappointed as our work there has been gaining a lot of support from the population, but as it turned out, we did need the time in Lahore to pursue our goal of creating a Pakistani school of osteopathy.

Our small team of returning volunteers was the perfect team for this year’s mission: Sheryl Hoo, pDO, always ready for anything, always generous. Faisal Naqvi, DO, the charismatic teacher in our team, with us for the 4th time, with enthusiasm and skills that make everyone love osteopathy. And of course, this time our two fundees, Haider Ali, pDO, and Usmara Zafar, pDO, participated in the mission as full members, as they received their certificate of osteopathy from SICO (Swiss International College of Osteopathy) in July 2012.  Thanks to all who have allowed them to complete their courses. They are now working on their research thesis so that they can obtain their DO: diploma of osteopathy.

We started our mission with a meeting with the leadership of Fatima Memorial Hospital System (FMS) to discuss the possibility of opening an osteopathic school within their system.  The school would be a partnership between the CEO (College of Osteopathic Studies, in Montreal) and FMS.  Never before has anyone tried to introduce the training in complementary medicine in a developing country. Our experiences, and the discussions at that meeting, certainly made us understand all of the challenges that exist in such a different economic and cultural environment.

In the Western world, professionals are keen to further their training in a modality that is popular and known to help patients get better with all aspects of their health.  The priorities in a developing country are to secure a safe job. For the profession of osteopath to become attractive to young professionals and high-school graduates in Pakistan, we need to secure the recognition of the profession by the Higher Education Institutions and government bodies of the country.

Shahima Rehman, chairperson of FMS, has already led her institution through numerous partnerships and pioneering endeavors to improve the well-being of her fellow countrypeople. Thanks to her experience and contacts, we were able to present our vision and project to high-level people in the government. Our coming every year for the last 7 years gives us credibility, unfortunately our results have not been evaluated or witnessed enough by doctors. We have collected the direct feed-back of the hospital patients we’ve treated, with a good 80% rate of satisfaction and improvement with osteopathy. We have seen amazing changes in their status: decreased fever, improved energy and color, improved digestive health or sleep, decreased pain, etc… We needed a tool to make our results visible to all.

To this end, we have decided to create an Osteopathy Day at FMH. Every Thursday, Haider and Usmara are now funded to treat patients at Fatima Memorial Hospital.  They will collect data on the evolution of their patients’ health score.  We are gratefully acknowledging the precious help of Prof. Amanullah Khan, a research expert, dean of the faculty of community health sciences to finalize the design of the study, and all the leadership of FMS who, through brainstorming sessions, helped us come up with this plan that will provide more evidence to help others embrace our vision of a healthier health-care system, able to provide cost-effective, complementary care in the remote communities as well as in the urban hospitals.

technical training school at Naim Shuk

Shahima Rehman, being such a fast thinker, plus understanding the value of osteopathy as community-care, was able to organize our visit to Naim Shuk, FMS’ community health-center on the outskirts of Lahore that first Monday afternoon.  We were very impressed by how holistic their center is. Centered around community health-care,  staffed with dedicated doctors, it also provides training schools in several professions (technicians, sewing,..) that ensure the graduates are able to earn and provide for their families.

Dr. Javaid Iqbal, director of the medical team there, quickly recognized a perfect indication for osteopathy: a woman came to Naim Shuk complaining of pain and swelling in her C-section scar for the last 3 years, for which she needed continuous medication.  We had the attending physician examine her and asked what her recommendation would be: injection of pain-killers, as her abdomen was very tender, and prescription of an ultra-sound for further investigation.  Instead, we treated this woman osteopathically and could release the scar tissue that interfered with the proper healing of the scar. This patient’s history was important here: this had been a third C-section, and the baby boy had died at birth. She had not been able to become pregnant again, and she was worried her husband would divorce her, as their 2 children were girls and he wanted a boy. Clearly, our intervention had to allow the patient to release the serious tension that was in her chest and diaphragm and kidneys, as a result of her stress, before attending to the relatively simple job of releasing the scar tissue.  This case was a good illustration of why we shouldn’t try to offer a “simpler, shorter” training in osteopathy: everything is connected, and trying to release a specific tightness when the body is not able to integrate it could bring aggravation instead of relief. We treated the patient again a week later, when she was already 50% better and extremely grateful.

While in the medical ward at FMH, we could treat several interesting patients, including a 17-year old boy with high fever because of multi-focal splenic abscesses. He had a motorcycle accident 2 months earlier and had been at the hospital for 2 weeks. Since he was not responding to treatment, a splenectomy was schedule for 2 days later, a Thursday. While we were given the boy’s history he was being bathed with cold compresses to try to bring his fever down, shivering and moaning. He looked underdeveloped, more like a 12 year old, indicating to us some underlying issue. Sure enough, Faisal found a severely restricted cranial base that must have been there from birth. We actually couldn’t believe our eyes, when while treating our next patients, we saw this boy sitting up and talking with his brother and friend, before deciding he wanted to go to the cafeteria, walking off his bed for the first time in 2 weeks!! We actually got worried that he would crash, which he did 2 days later, but in the meantime, we asked his doctor whether he would consider postponing the surgery, to give a chance to his body to clear the splenic infection on its own. In view of the spectacular changes manifested, he accepted. Faisal was able to treat this boy 4 times in 10 days, and he was discharged, being active, without fever and seeming healthy. Osteopathy, like allopathic medicine, has its miracle stories and its limits. Unfortunately, the patient had to be operated on to remove his spleen anyway a few days later — his body hadn’t been able to clear the abscesses on its own. Possibly the walls of the abscesses had calcified. From our experience with trauma cases, certainly osteopathic treatment right after the fall would have avoided all these complications, and certainly the boy recovered better thanks to the improvement in circulation of fluids and nerves.

Every year, we treat many cases of motorcycle accidents, young men immobilized with limb fractures that are infected. The worst outcome is amputation, when even strong antibiotics are not effective. Osteopathy restores normal alignment and mobility in the tissues in the entire body, allowing the immune system to reach the wound and fight the infection. How much money and misery could be saved with osteopathy available to all?

Dr. Pervaiz

Sheryl and Usmara together treated a woman with multiple health issues: she had kidney disease, an enlarged liver, fever, generalized pain and vomiting. When we visited her the afternoon after her treatment, she already had no more pain, fever or vomiting. A week later, we called her and found out she was home and had stopped her medication because she had felt so good. She was starting to feel worse again, understandably because of the nature of her chronic kidney disease. Usmara could urge her to visit her doctor asap, and resume the medication still needed. This is a clear illustration of the importance of working as a team between osteopaths and physicians.

Dr. Pervaiz, orthopedic surgeon at Shaik Zayed Hospital (SZH), with the support of Prof. Anwaar Khan, then the chairman, was the first to open hospital wards to our teams of volunteers in 2007. This year again we split our time in Lahore between FMH and SZH. Residents recognize us from year to year, and there are always many patients for us to work with. Because of time limitations, we restricted our work to the orthopedic and pediatric wards, two departments where results can sometimes be immediately visible: children stopping their loose motions, sleeping through the night, pains being relieved. Our work there is beneficial for the patients, but the overworked doctors are happy to discharge their patients faster, without paying attention to the fact that it was the osteopathic treatment that made a difference. That is why our research at FMH is going to be so helpful to support our vision of integrated health-care.

group of physiotherapists at NISRA University

Last year, we met a physiotherapist trained in Belgium. Arjumand Mahmood, PT, who is ready to start osteopathic training as soon as it becomes available in Pakistan. In the meantime, she helped Dr Muhammad Naveed Babur, principal at ISRA (school of rehabilitation sciences in Islamabad),  organize a half-day presentation of osteopathy to heads of physiotherapy departments and teachers in the region.  Faisal gave them some practical demonstrations of osteopathic techniques to allow them to realize how differently osteopathy acts: how it works with the biodynamic force within the patient to induce a releasing of tightness, as opposed to stretching or mobilizing with outside forces.

We thank Dr. Naveed Babur and Arjumand for having brought together such a smart group of physiotherapist leaders.

When back at FMH in Lahore, we were invited to present at their weekly medical presentation. It was very well attended, by doctors and students, and we focused here on osteopathy’s results, presenting data from research as well as the principles of osteopathy. For instance a research with 110 babies showing 5-day decrease in length of stay (LOS) at the hospital for preterm babies treated with osteopathy. Same decrease of  LOS was found for general surgery patients. A study on 57 patients compared results for otitis media on children: osteopathy is very effective to avoid surgery or antibiotics. A good study showed the benefit of osteopathy for IBS patients, a diagnosis that cannot be helped very effectively by allopathic medicine. Etc…

Thanks to OWB board member Aleema Khan, we had the pleasure to meet and treat staff and members of the Pakistani Cricket Board. They have a team of 14 talented physical therapists to support the precious players, and we are trying to organize an introductory course just for them. Faisal, who has a background in athletic therapy, helped an injured player recover mobility and alignment, and had excellent feed-back.

For the third year in a row, Aleema organized a dinner at the Punjab Club at the end of our stay, to gather friends and supporters of osteopathy. A very smart and dedicated group of people, doctors, educators and benefactors came to hear the latest developments. Thanks to their and your support, Osteopathy Day at FMH can be funded long enough to gather data to help ease the introduction of osteopathy in the health-care systems of Pakistan and the rest of the world.

Although the CEO and FMH are ready to start and signed a MOU of mutual exclusivity in the partnership, there are still many steps till the first osteopathic school can open in Pakistan. This pioneering endeavor is challenging and a growing experience for us all. We are very grateful to all who are supporting our vision in any way they can. We are proud to contribute to osteopathy’s growth with the research now taking place at FMH.  Our sincere thanks to Shahima Rehman and her team for providing such a fertile environment for our project. The work continues…

To keep up to date with our project, please visit our web-site, www.osteopathywithoutborders.com or our Facebook page.

The first Pakistani osteopaths.

This year’s mission was the 6^th and different from the previous ones in many ways.  It marked the completion of the osteopathic studies of our two fundees, Haider Ali, pDO, and Usmara Zafar, pDO, who successfully passed their 5^th and final exam at the Swiss International College of Osteopathy (SICO) 4 days before our team’s arrival in Lahore.  It has been an arduous and exciting journey, and we congratulate them on being the first proud graduates of osteopathy in Pakistan.  The completion of this first phase, for which we have to thank our most generous donors in New York, also marked the beginning of our second phase, setting up an osteopathic school in Lahore, with teachers sent from Montreal and Haider and Usmara as assistant-teachers.

As a first step to bringing the program to the country, one of our returning volunteers, Faisal Naqvi, DO, taught a two-day “introduction to osteopathy” course at Fatima Memorial Hospital (FMH) that was attended by 20 physical therapists and very well received.  We had the opportunity last year to be introduced to FMH, a private trust hospital that has grown from a simple birthing center in the 60s, to a full system with medical schools and outreach programs, all to support a generous philosophy of giving the best care to the patient, and considering the patient as a whole.

Shahima Rehman is a most inspired and inspiring leader, always staying focused on her goal of creating a more peaceful world, very attached to holistic care of patients, even within an allopathic hospital. We have never seen a hospital and medical school with so many employees smiling and happy to do more for their patients.  When we introduced our project, it seemed a very natural match of intention and philosophy. Thanks to Mrs Rehman’s leadership, doctors and physiotherapists welcomed the introduction to a new method that could help their patients get better faster.

During the course, the volunteers, Anoushka Lapchuk-Dube, pDO, and Sheryl Hoo, pDO, and Haider and Usmara, acted as assistants providing hands-on validation of the new palpation that was taught.

After the week-end course, the team moved on to the wards, where we treated patients in medicine, pediatrics, orthopedics and obstetrics.

One patient was treated while in the labor room.  She was 38 weeks pregnant and suffering from severe low back pain for already 3 months.  She had had a C-section prior which scar also hurt, with pain radiating down both legs. She reported an immediate relief of her pain after the treatment that certainly will promise an easier birth.

Like at Shaik Zayed Hospital (SZH) the previous years, orthopedics patients were victims of traffic accidents. The traumatic injuries had caused strains and tightness in their entire bodies, which osteopathy could release. The patients had immediate improved comfort and decreased pain. The improvement in circulation to the wounds insured optimum healing.

In pediatrics, Sheryl treated a 12-year old boy with hepatitis.  His medical history included a severe fall on the forehead at 5 years old that blocked his breathing passages and stiffened his thoracic spine. This latter finding has been present with every hepatitis patient we’ve treated over the years.  Had this boy had access to osteopathic treatment after his fall, he would have been relieved from his breathing problems right away, and could have been protected from getting sick with the hepatitis virus, his liver having then recovered normal fluid circulation and nerve conduction to protect itself.  We are hoping for Haider and Usmara to be able to complete an osteopathic research study on hepatitis, which affects so many in Pakistan. Patients get sick during their active years, bringing 80% of those affected to the sorry state of chronic liver disease that robs them of their vitality and forces them to live several years very weakened before an early death Our experiences in the hospitals, where patients show marked improvement immediately after their osteopathic treatments in their energy, color and digestive function, lead us to believe osteopathy could significantly improve the prognosis of these patients.

Shahima Rehman visited the patients we treated with Dr. Haroon Ihsan, medical director at FMS. She had her team make a complete review of the feedback from our patients and reported that 99% of them were satisfied.

We could never have gone so far in our project without the support of Dr. Pervaiz Iqbal, orthopedic surgeon at SZH. Again this year, he opened the doors of the different wards of this large public university hospital.

Sheryl and Faisal treated a young woman who was scheduled to have a liver transplant due to a non-defined disease. She was anxious, with severe ascitis (fluid accumulating in the abdomen due to portal hypertension).  As usual with liver disease, we found an extremely tight thorax and rigid cranium, which interfere with the sympathetic and parasympathetic conduction and breathing. After a very deep treatment integrating the whole body’s ability to respond to the liver disease, she felt remarkably better. She was exhilarated as she was poking her belly that was now soft. The treatment didn’t affect the liver that was destroyed by the disease but we can expect that her physiology will be able to do its work of self-regulation as she goes through this difficult process.

I treated a woman who was waiting for surgery several days after a terrible motorcycle accident. She had numerous fractures in her whole body, plus a huge bedsore covering her entire back. I could only do some cranial treatment, as I couldn’t touch her body, and even her jaw was broken, and her eye-socket was hurt. When we visited the day after, her attendant reported she had stopped groaning, manifesting less pain.

Another hepatitis patient, with severe fluid accumulation that had required a drain put in his lungs, was crying from pain when I started treating him.  He cried with relief when we were done.

Nagar

2011: boy in Nagar showing where he hurt before his osteopathic treatment the previous year

Our week in the Northern Areas, 22 hours by road from Islamabad, was a clear confirmation of the benefit of returning to the same village every year. In two locations in this very rural and remote village, at a school and at the local prince’s modest palace, we operated a clinic with patients knowing what to expect from us.  We heard excellent feed-back from our treatments last year, with for instance 2 boys who had similar issues of poor eating and sleeping and aggressive behavior being now, according to their fathers “different children”, normal and happy. Some other children with mild cerebral palsy had seen major improvements in their walking.

A young man had tried to be treated last year, but had arrived too late from Islamabad.  This time, he was here on the first day and presented with knee pain for the last 2 years.  Anoushka mentioned when she started working on him that his cranium was incredibly rigid.  He became cold during the treatment and started shivering. That’s when he told his story of being attacked while at university, beaten with bricks and stones. The treatment allowed the physical and emotional trauma to start being released. We saw him the following day: he had had the best night sleep and had brought a multitude of patients for us to help.

I treated an 8-year old boy with clubfoot bilaterally. He had had surgery, obviously not so successful, as his feet were very deformed, turned in like a fan, very arched. He was walking on the lateral edges of his feet, and his knees had developed an abnormal extension, to compensate for the lack of dorsi-flexion of his ankles. Club feet are easily released with osteopathy when treated on a new-born, as it is due to a bad position inside the uterus. But when I saw him, I was not sure how much I could help after 8 years of putting his weight on his feet in this abnormal way.  Working with the inherent auto-regulation of the body, which always tries to go back to normal, we could get good releases in the mobility of the feet and ankles and sure enough, his lower leg muscles, which had not worked for years, because of the lack of mobility, started to work again right then at the end of the treatment.  Had he been treated as a baby by a local osteopath, none of this pain would have happened, and the money for the surgery would have been saved.

The most magical moment in Nagar happened when Faisal and Anoushka were treating on the lawn of the palace (Sheryl and I were treating the women indoors). There was a crowd of 100 to 150 people, including many children, quietly watching the treatments. Some men even started to mimic osteopathic treatments on each other, for fun. Our two colleagues reported feeling a beautiful energy and increased focus that helped their treatments. It confirmed that osteopathy is now well known in the village.

We continue to inform villagers of the harm of flattening their babies’ heads for beauty.

Last year, invited by Dr. Wajahat, a pediatrician we met in 2007, we spent a day at Gilgit hospital, a public hospital in the main city of the mountains. The results having been conclusive, Dr. Wajahat now invited us to work at a small private foundation hospital, Sehhat, directed by Zulficar Ali.  They had set up a special room for us and we had patients to treat there all day. Mr Ali would have loved to see us stay longer.

Our main goal for this year was to introduce osteopathy as a possible career for people so that we have a good group of students when we open the school hopefully in 2014. Aleema Khan, OWB board member and angel, is very keen on helping candidates from the remote Northern Areas get the training. We hope that through our demonstration of our work, candidates will emerge. We arranged a meeting with the medical general manager of the Agha Khan Health Service Program in Gilgit, Dr. Abid Hussain. Luckily, Dr. Jim Myers, CEO of this program in Islamabad was present too. The Agha Khan Organization provides a lot of health and education services in Hunza valley, across from Nagar. Osteopathy would be a natural extension of the good work they are already doing for their people.

On the 5^th of July, at the conclusion of our work in Lahore, we organized with Aleema Khan a dinner with the senior management of FMH, Dr. Pervaiz, Jehanzed Khan, the previous health secretary, and past patients who now became committed donors to the viabiliy of our project.  We will need funding to cover the difference between western costs for the teachers that will be sent from Montreal’s CEO (College of Osteopathic Studies) and local tuition fees. That need for funding will last only until there are enough local osteopathic teachers, at which time, any medical school could have an osteopathic school attached to it. That’s when our vision of a different health-care system can start showing its results, with osteopaths providing services at the community level, in neighborhoods in the cities, in villages in the rural areas, as complementary medicine in the hospitals, as preventative medicine in the schools.

The complete team of volunteers, with Aleema Khan and the first Pakistani osteopaths, Usmara Zafar and Haider Ali.

That will allow the population to have access to cost-effective care at an early stage of disease, preventing some of the terrible complications we see in the hospitals. That will allow a better allotment of scarce allopathic resources, functional problems being often completely relieved by osteopathy.

Osteopathy can be a fantastic career for those interested in medicine who don’t want to be doctors but want to be part of the healing process and like to spend time with their patients. It is a very gratifying career that is also intellectually satisfying, offering great flexibility of work schedule and settings.

We want to take the opportunity of this 2012 report to thank all those who have supported our project so far. It was a formidable bet when we started in 2007 and this year we could see that osteopathy has healthy roots in Pakistan. It is for us now to grow it steadily and healthily so that the sick and weak can become strong and healthy and provide the full potential of their creativity and energy to society.

The osteopathic program that will open in Lahore in 2013/14 will be open to doctors and physiotherapists and other holders of a bachelor in health sciences. It is a part-time post-graduate program that consists of 6 5-day courses per year for 5 years, followed by a research project.

The program will be organized by the CEO in Montreal, which will send senior teachers from Montreal for each course. The CEO already has a network of 8 schools in Canada and Europe. Its program is validated by the University of Wales, in Great-Britain, allowing its graduates to obtain a B.A (hons) in osteopathy from this university.

You can find more information about the program on the CEO (Montreal) and CCO (Toronto) web-sites.  Candidates to the part-time program, holders of a bachelor of health sciences, should forward their CV, together with a letter of interest, to Syed Haider Ali.

OWB is actively preparing its 2012 mission.  We are pleased to announce that Faisal Naqvi, DO (Q), one of the early volunteer to the missions in 2007 and 2008 is able to join us again, and will give an introductory course to osteopathy. This will be a wonderful opportunity for the medical professionals in Pakistan to learn some basic tools of osteopathy that they will be able to integrate into their existing practice.  Our two local finishing students will be assisting this hands-on work-shop. See the announcement.

Haider and Usmara, now in their fifth year of osteopathic studies, proud leaders of osteopathy in their country, have given two presentations at universities this Fall.

As we continue to work at making the opening of osteopathic school in Pakistan a reality, bringing information to potential candidates to the program is essential.

On October 1^st, they were invited by the physical therapy school at Faisalabad University.  Faisalabad is Pakistan 3^rd largest city, 80 miles west of Lahore.

Their presentation was part of physio day celebration.
 They were invited to present osteopathic philosophy and chose to demonstrate correction of a 1st rib and muscle energy concept. They were pleased and impressed to have so many inquiries from the students. They were also able to meet with the dean of this recent and dynamic private university and share their experience with the teachers.

This past Saturday, on November 26^th, they used the same material to present at Riphah International University in Islamabad.  There they addressed practicing physios and physios doing a transitional doctor of physiotherapy course.

During the 2 hour-event, that included time for an interesting question and answer period, attendees manifested great interest in the philosophy of osteopathy.

The director of the program, Dr. Asghar Khan, showed particular interest, as he had done his D.P.T. at A.T. Still University in the USA.

Haider and Usmara were thrilled to have this wonderful opportunity to present to colleagues coming from the each of the main cities of Northern Pakistan.

Thanks to such presentations, we hope more and more doctors and physiotherapists will realize how osteopathy can be a most useful tool to help restore health in their patients. Osteopathy can be used alone, or in combination with allopathic care, depending on conditions. It can greatly alleviate the burden of over-worked doctors by making patients better faster, and with long-term improvement in their own ability to maintain homeostasis.  It allows physiotherapists to be significantly more effective with their orthopedic patients, and open the range of diagnosis they can work with.

Please sign up on the contact page if you are interested in receiving updates on the creation of the first Pakistani osteopathic school, scheduled for 2012 or 2013.

Osteopathy Without Borders (OWB) was founded in 2007 to bring the benefits of osteopathy, a form of low-cost, effective manual medicine, to Pakistan.

OWB organizes, with the support of the Collège D’Etudes Ostéopathiques (CEO) in Montreal, Canada, yearly humanitarian missions, bringing volunteers to work in a hospital setting in Lahore and a rural mountainous area.  Its main mission is the training of Pakistani osteopaths.

It is recognized by all who work in health-care in developing countries (WHO, MSF, …) that natural therapies should be part of the solution to provide proper health-care to their population, as the high-costs of allopathic care is not affordable for all. Unfortunately, this kind of training is not available to local students as cost is prohibitive. OWB was created to fund the initial training of osteopaths in Pakistan.  Once enough local osteopaths exists, local osteopathic schools can function independently. Read the rest of this entry »

Published in The Friday Times, Pakistan’s First Independent Weekly Paper, July 22-28, 2011 – Vol. XXIII, No. 23

Sylvie Erb is a co-founder of Osteopathy Without Borders and leads humanitarian osteopathic  missions to remote places in the Northern Areas every year. TFT talked to her about her organisation’s plans in Pakistan.

The Friday Times: What is Osteopathy? Tell us about its philosophy and scope.

On April 19, 2011, Haider Ali and Usmara Zafar, our two fundees, gave a presentation at the School of Physiotherapy at Mayo Hospital, Lahore. It is part of King Edward Medical College and is the oldest and biggest hospital in Pakistan.

Their presentation was about muscle energy, which is one type of technique developed by an American osteopath, Fred Mitchell Senior, D.O. in the late 1940ies. Read the rest of this entry »

The foundation Osteopathy Without Borders (OWB) was founded in 2007 to raise funds to train Pakistanis as osteopaths. Haider Ali and Usmara Zafar, physiotherapists in Lahore, have now finished their 3rd year, out of a 5-year part-time study program.
Read the rest of this entry »

This year, with the educational support of the CEO, who will send senior teachers from Canada and the fund-raising support of  the Imran Khan Foundation, we’re working to open an osteopathic school open to doctors and physiotherapists.

The goal is that once there are local osteopaths who can provide supervision, it will be possible to open full-time programs open to students out of high-school.