A PT reflects on an assignment overseas and how it helped him reconnect.
Working pro bono over the course of four months is enough to make anybody think long and hard about how much their time is worth. After all, that’s a third of a year, and it was now time to return to the usual expenses of life as a young couple.
Undoubtedly, my wife and I experienced a fascinating and unique corner of the world, but a third of a year’s salary could buy a whole lot of useful things – things like hardwood flooring, a car, vacations to countries with potable water. My assignment through Health Volunteers Overseas (HVO) in Thimphu, Bhutan, focused on teaching physiotherapy technician students, as well as educating and consulting with my local counterparts. We met some wonderful people along the way too, but I wanted to know that my donated time was successful, that it was worth something tangible.
We’re told the value lies in acknowledging your privileged position in this world by helping a less-privileged one. It’s supposed to make you feel good – better, in fact, than if you’d been compensated to do it. Whether it’s a weekend helping out in a rough neighborhood or an overseas commitment, at some point all volunteers question how much their presence has actually mattered. Indeed, we’d like to feel our efforts have set in motion a profound and long-lasting change. Upon returning home, we want to impress our family and friends with achievements attained through worldly ways of overcoming cultural barriers. I’ve always been impressed by those people.
I bumped into Hendrik Visser one evening at Karma’s Coffee. While consulting on sustainable rural development, he had still found time to establish a non-profit animal hospital (Bhutan Animal Rescue and Care) with his partner. This guy was a dynamic expat who got things done. It was my third assignment for HVO, and becoming clear that quantifying accomplishments in developing nations can be a difficult task. Why was that? Giving a good-natured laugh at my concerned tone, Hendrik replied, „Sometimes we are trying so hard to find something meaningful to do, that we fail to realize we are already doing it.“
Maybe specific outcomes have very little to do with the individual’s impact, and the real result is the experience itself, a simple interaction and greater understanding amongst cultures.
Making an Impact…Or Not
I had been teaching 10 classes per week over the past four months, and in my free time had given the staff numerous continuing-education lectures and practical lab sessions. Good stuff too, stuff that cost thousands in course tuition to learn myself and stuff that would benefit both patients and the department greatly. A decade’s worth of enthusiastic volunteers have done the same here: surely, sweeping progress was taking place.
On the way back from teaching class, I stopped by the physiotherapy department. It could have been a clinic anywhere in the world: a handful of patients laid on hot packs, a few performed exercises unsupervised in the back of the room. A queue of new patients gathered at the door while a stroke survivor worked with an attentive therapist.
Where were the dynamic professionals collaborating and practicing evidence-based medicine? Am I just unable to see the progress I envisioned through this small window of time? Maybe, somewhere in the building, at least one of the physios is using something I taught to get someone better. I’d feel good about that. „Sonam, how’s that solitaire going?“ I quipped – immediately regretting my sarcasm. „Oh, good sir,“ he replied sheepishly, sliding his smartphone back into his white coat.
This was a new hospital full of educated individuals. Smart people who had good days and bad days, just like everywhere else in the world. Still, I remember a similar assignment in Lima a few years back, on a day surrounded by inquisitive and engaged therapists. What made this time different I wondered: did I just catch them on a bad day, or do the unique cultural attitudes here mean I should adjust my own attitude?
Luck had it that I was paid a visit by Ronnie Leavitt, PhD, PT, an expert in cross-cultural rehabilitation. She was traveling through Thimphu, and we strolled the hospital campus on a typically blustery November afternoon. It was only 3 p.m., but the building was nearly empty of staff. Long shadows cast from the surrounding high ridges cloaked the valley, giving a sense that the day was already winding down. „Are some countries simply better equipped to utilize foreign support than others?“ I asked.
„There is such great variability in cultures,“ she replied. „You have to change your definition and expectations of success. It begins with a passionate individual, and cumulatively over time is where the bigger and more visible changes take place.“
Big changes had taken place here, largely due to the efforts of Linda Wolff, MPT. She is the passionate individual who has been shaping this program for over 10 years. Where rehabilitation services were previously non-existent, her commitment to the volunteers and Bhutanese staff have now made physiotherapy available to thousands in need across the country. I’d say that’s a pretty visible change – one that I hoped I played a small part in.
An outgoing orthopedic surgeon had been orienting his replacement volunteer and was pondering the same dilemma. „Michael,“ he said in a deeply reflective tone. „I just wonder if I’ve really made a difference in my short stay here.“ Roger is a very thoughtful and kind man who had been teaching a couple of ortho tech students as well as consulting with the staff docs. „Sure you have,“ I said, armed with my fresh new perspective. „You just have to be okay with the fact that your impact was small, you’ll probably never know what that impact was – and you’re going home with some really good stories.“ Roger is well aware of this (he’s much older and wiser), but it was the first time I really got it.
„Eighty percent of success is showing up.“ – Woody Allen
Sometimes, just showing up is valued much more than being productive. I think the Bhutanese would agree with that. Simply being present shows you care, and that’s an important component of the volunteer experience that many of us Westerners completely miss. Sue, an American counselor here, had been chatting with my wife regarding her frustrations on the slow pace of getting something, anything, done across a variety of organizations in Thimphu.
„You know,“ Sue said, „just walking in the door and saying you’re here to help is a big deal. You’re a resource they can pull from when needed. They may not use your help this week, or this month, or ever … but it’s appreciated nonetheless.“
Volunteers and non-profit workers in the developing world love to go on about the efficacy of their individual contributions, but in reality, most of us are part of a long chain of incremental change. For some, the right elements fall in place for real progress to occur; others come and go without observable impact. Ultimately, we are all showing up with the intention to help – and that’s a good thing. Or, as Ms. Leavitt put it, „At the very least, we leave with a wiser and more realistic perspective of the world.“
As our time in Thimphu wound down, the students came over to cook us dinner, excited after finishing the first of their exams. Spinning around the kitchen, they enthusiastically whipped up some palate-incinerating Bhutanese chili dishes. I remember thinking: Where will you guys be in a year? Will you recall something from our classes that will improve someone’s life – even just a little bit? Will your lives really be open to greater opportunity after graduation? I’ll probably never know the answers to those questions, but I think I’m okay with that now.
Here and there, I got words of thanks from staff grateful for bits of information they found helpful (folks whom I was sure weren’t paying attention) or from friends in the community who appreciated some physio-related advice. More than a few Bhutanese I’ve met in passing gave a sincere, „Thank you for helping Bhutan,“ after hearing about HVO’s work here. It’s hard to stay an outcome-driven Westerner when people are so grateful.
There are plenty of economically developing places within driving distance that could utilize health-care volunteers just as much as Bhutan – right across the border in Mexico for instance, or disadvantaged neighborhoods within our own cities. But those places aren’t in the Himalaya, and I’d be lying if I said that an exotic and authentic experience wasn’t a big motivator for going to Bhutan. Not wanting to be some hippie backpacker, I wanted to feel good about doing it; I wanted to feel like my time mattered, so I volunteered.
Selfish? Maybe a little. But now there’s four, bright, young Bhutanese students who have a solid foundation to make a living and better their communities. I have a whole new respect for what it takes to be a teacher. I’m going home with those good stories I was looking for, like helping a monk with his back pain at a mountaintop monastery or getting a Bhutanese friend back on his mountain bike. Can I articulate exactly what I’ve accomplished here? Not really, but I showed up and I gave it my best. And that, I do feel good about.
Michael Tabasko has been active with HVO since 2006 and has volunteered in Vietnam, Peru, and Bhutan. He is currently practicing at Capitol Orthopaedics & Rehabilitation in Rockville, MD. In his free time he enjoys writing, traveling and adventuring in the mountains with his wife.