Dear Friends and Supporters,
Below is my activity summary for Sri Lanka March15th- April 24th. Our decision to follow through on our second training after raising only the minimum to cover expenses for a six week trip including airfare, came literally three weeks prior to departure. A lapse in our commitment to conduct more training in Sri Lanka was just not an option. It is my heart felt belief that this decision to maintain continuity of this program was essential for its long term benefit and impact.
Our initiative was a huge success, accomplishing far more than intended and setting in motion future growth of our programs there, however, I feel that a greater optimization of my time would have been possible had we had adequate funding to plan my visit well in advance.
Underscoring the need for more support was the difficulty for some regional therapists interested in the trainings to rearrange their schedules to attend on such short notice. Additionally, many of the patients who would have benefited from sessions were not informed of my availability. At the very least, a two to three fold leverage of my training time may have been possible resulting in more educated therapists and subsequently hundreds more patients receiving enhanced care throughout the southern province.
Despite these constraints, the enthusiasm of the Navajeevana's administration and staff at our decision to come, coupled with the efficiency of Real Medicine's Sri Lankan staff clearly made best use of my time.
Real Medicine Team Whole Health Signed Activity Verification Documents
We are deeply grateful to those who supported this effort. Your contributions came at a critical time for this humanitarian aid project and ensured its success and its future.
For a quick summary of our accomplishments please see the entry on the "What's New Page" by clicking here.
Here we go......
BodyWorkers Without Borders/Real Medicine Team Whole Health enhance physical therapy treatment protocols and highlight the need for ongoing Movement Education as a primary treatment option for chronic muscle pain and functional limitation due to PTS disorder, Parkinson's Disease, Ankylosing Spondylitis, Sciatica, Compensatory responses to injury and abuse trauma.
Getting There and the first couple of day...
After being rerouted from London to Mumbai and then to Columbo, Jen and I arrived in Tangalle late on the March 14th. After settling in over the next day, I visited Navajeevana to meet with Kumarini, the founder and now Chairperson as well as meet with Mr. Arunkumar, the head of the Physical Therapy department to discuss coordinating my time there. We had a brief meeting to arrange time the following week to plan our schedule. I then went to the PT department to visit with my friends, Mr. Samantha Udagama and Mr. Gamani whom I met and trained with last year.
On Friday March 16th, Kelly Prentice arrived to do research for her article for the AMTA's Massage therapy Journal
Saturday Evening, March 17th, We met with Martina Fuchs MD, and Dr. Rubina Mumtaz , RMF coordinator from Pakistan along with 20 others in Sri Lanka who are participating in Real Medicine activities in the southern province. We all shared a similar vision to serve and were grateful for the vehicle of Real Medicine that has brought us together.
Monday March 19th we were picked up early by the RMF van and made a quick stop at Navajeevana so Martina and Kumarini could meet to perhaps provide much needed services to one another. It turned out that Navajeevana can provide the Psychological Services and outpatient Physical Therapy need at Real Medicine installations. Kumarini also spoke of their need for funding for a Head Physical Therapist which is now being investigated by Kelly and I at Good Shepherd Rehabilitation Hospital in Allentown, PA. Upon our return we met with the VP of rehabilitation services to discuss this possibility. For more on this latter story, please click here.
After visiting with Navajeevana we were taken to two preschools supported by RMF where we were greeted with flowers and then we went to Tangalle Hospital to follow up on the installation of the water clay sterilizer provided by Direct Relief International at the request of Dr. Fuchs.
Below is a copy of the first email report I provided to Martina. Subsequent updates were done over the phone as there was too much activity to report and summarize in a timely manner. I'm grateful for the support of Minerva Fernando, coordinator for RMF in Sri Lanka. I am also thankful for my trusted Tuk Tuk driver Prasad, and friend Sarath who loaned me his motorcycle pictured here in Yayawatta village so I had complete flexibility and means to meet the many demands of each day.
Dear Martina:
On Friday afternoon, March 23rd, 2007, we, (Kelly Prentice, Jen, and Virginia (the RN I spoke to you about and I) were taken by Minerva to the Yayawatta Village. There we were greeted with smiles, flowers and the warm welcome of Sri Lanka we have come to know so well.
Our arrival was well coordinated by Minerva who had assembled not only the children you had mentioned but also many other people of the village and surrounding area with ailments for me to evaluate. After meeting Madumekala and her family, along with some of the other children being cared for by RMF, I met with some of the other men and women who had come to see me. Conditions that were most prevalent were arthritic and painful joints and interestingly, varicosity in the lower extremities of women.
I agreed to return to the clinic when the physician was present to provide sessions and recommendations for those whom I feel would best be served by The The Trager® Approach. For the women with varicose veins I thought perhaps I could schedule some time to work with them as a group to teach them some Mentastics® self care movement exercises to reduce the tension in their hips, legs and feet to help alleviate or relieve the pain associated with this condition. (Varicose Veins are contraindicated with The Trager® .)
After giving the foods and supplies to the children sponsored by Real Medicine, we took a walk through the village with Lexia to visit with some of the residents who could not make it to the clinic. We visited a young girl with Cerebral Palsy named Chamani and an elderly couple with chronic pain related to inflamed joints and muscle tension. When I visit later this week to work in the clinic, I will make some time to see these patients.
I wanted to point out how well Minerva worked with the clinic staff and Lexia, the Yayawatta village manager, to make a delightful yet productive afternoon visit. Clearly the people of the villages have a strong connection with Minerva and respect both her commitment to being the voice of their needs and the liaison for fulfilling them. It is evident that she works very hard to maintain a strong presence and be an efficient and reliable representative of the Real Medicine Mission.
I'll look forward to returning to the clinic to work with the patients and will provide brief reports early next week.
Saturday and Sunday March 24th and 25th 2007
Navajeevana Rehabilitation Center - The Trager® Workshop.
Over the course of last week, I had an opportunity to give treatments to members of Navajeevana's Physio and Occupational therapy staff. This past weekend, March 24th and 25th I conducted a two day training for 4 members of their staff, and three others. This training included self care and nutritional modules as well as a review of a the basic treatment protocol of The Trager® Approach based on the fundamental principals of the approach. For a more comprehensive report on this training and the training sessions conducted April 7th, 8th, 10th and 12th please click here.
All members participated with much enthusiasm and were very quick to pick up the techniques reviewed. We will be reviewing clinical applications throughout the coming weeks and there is a second training scheduled for April 7th and 8th. I have also selected two patients whom I'll be treating at least twice weekly with The Trager® Approach. I've arranged to pay for their transportation to Navajeevana so they may participate in a more in depth case study over the next 3-4 weeks as suggested by Arun, the head physio at NJ. I'll update you on their conditions as we get underway tomorrow, Wednesday the 28th. I also hope to connect with Claudia at GTZ this week or next. I now have a queue of others who are interested in sessions.
Today, March 27th, 20007 Minerva and I visited the Tamil Montessori Pre-school in Dickwella. Again it was a pleasant and well coordinated event and provided another example of Minerva's hard work to optimize
the Real Medicine mission. How beautiful it was to discover that this was the first seed that Minerva planted on behalf of Real Medicine.
Mr. M.M. Imthiyas, the director was an inspiring soul as well with the community’s best interest very much at heart. I couldn't help but feel much gratitude to everyone for sharing with me the blossoming work of Real Medicine in Sri Lanka. It is so moving to see so many smiling faces and to be part of such compassionate efforts to support these communities in need.
Psychological Services
I’ve met with both Kumarini and Christine of Navajeevana (NJ) to follow up on the discussion we had at our group meeting on March 19th regarding NJ providing Psychological and Physiotherapy services to RMF’s clinic at Yayawatta Village. Madame Christine will be in charge of this. She was busy through the time I left and unable to meet to initiate the process. I wrote a letter to her reviewing the details and introducing Minerva Fernando as the RMF contact to arrange services. Please see the attached letter. Minerva is very familiar with the needs of the Yayawatta community and will be able to facilitate this process successfully. Additionally, I’ve provided the Navajeevana therapists with my notes from my clinical sessions along with recommendations to support their participation at Yayawatta when they begin field visit activities there. They are very much looking forward to working with RMF and helping the village.
Note: Below is a continuation of the above report summarized by date. Interpretation was performed by RMF Sri Lanka Coordinator Minerva Fernando. All Subjective patient feedback has been provided through her interpretation. * All patient conditions were addressed with The Trager® Approach and Mentatstics® Movement Education. While the following is listed by date as a chronicle of my RMF clinic activity, I've provided a individual Case Summaries for Patients from Navajeevana and Yayawatta here. These are my actual notes at typed or scribed during my clinic time. I've added some photos from each session as well. I've seen most of the patients multiple times during the course of my trip. Please read through to see their progress.
Wednesday – March 28th 2007
Yayawatta Clinic
I met with Mr. Pattisingho and older man who was in a pretty severe bicycle accident which left him with a broken arm requiring extensive surgery. He explained that he had a broken left humerous and has pins in his arm – bone graft from left hip (numbness now in left hip and left rib cage)
I noticed the L clavical severely misaligned. He explained that surgery at the time would have threatened his life.
He complains of pain in neck, shoulder and upper arm as well as the numbness previously mentioned.
I Performed Trager® on neck, shoulders arms, hips, ribcage to facilitate release of muscle holding. Heavily restrictive. deeply seated muscular patterns throughout shoulder girdle, ie. in trapezius, deltoid, scapular region.
After session, I reviewed with him a number of Mentastics® (self care movement/awareness exercises) for neck, shoulders, arms, and hips and encouraged him to practice these a couple times each day.
Post session he felt freed of shoulder and neck pain but still had numbness in hip. Rib cage had slight sensation.
Patient 2
Summary: I met with the mother of a Young Girl who, as she explained has no memory of instructions or any action…always receiving instructions but having no response or memory of such. Perhaps she is autistic. At first she was frightened to meet me but then she let me hold her hand for some time. Still a bit nervous. Explained to mother that there was nothing I could do but would suggest NJ Psychological support (she has been to NJ) – they said she needs socialization
Patient 3
Summary: I met with the mother of a deaf boy who brought me all of the diagnostic sheets for her son which state that her son is completely deaf. Even a hearing aid would not be of benefit. – actually current aid is not helping. The boy is taking signing classes in Matara. I encouraged his mother to learn how to sign to support her son’s progress and ability to communicate.
Mrs. Wanigabadu (Amil’s Mother) – swollen left elbow – complains of pain. She had been pinned down by debris on her arm during the tsunami. She mentioned "I am not afraid of the sea however, I don't ever want to see it again."
Excessive muscle holding pattern/tension in trapezious, bicept etc. I addressed her neck, both shoulders, arms and ribcage. This facilitated much relaxation. Instructed her in Mentastics® movement exercises to maintain this free feeling. She reported no pain at close of session.
March 29th 2007 – cannot find notes from this day. My apologies. I wrote them on the back of a piece of paper that was then misplaced.
March 30th - RMF Yayawatta Clinic
Amil Wanigabadu – I met Amil on my first visit to the clinic. His mother said he was a “troubled” or problem child, always hyper and fighting. He seems stressed, apparently picks at cuts (his legs are a mess). Minerva explained that he is hit on the back in punishment for his behavior. Amil and I had an immediate connection on our first visit. As we toured the village he walked with me holding my hand as friends in Sri Lanka often do.
I gave Amil a session to give him the feeling of “what is peaceful, relaxed, easy, soft.” After the session, I encouraged him to remember this feeling; that this peaceful place he was experiencing was inside of him and only a thought away. He seemed a bit perplexed that a stranger would have taken interest in him but was very happy to receive the session.
Mrs. Wanigabadu (Amil’s Mother) – 2nd visit - arm swelling, much improved about 80% less, no pain, very relaxed. My sense is that this pain and swelling was PTS related to her traumatic experience in the Tsunami.
Mr. Pattisingho – 2nd visit - Reports no more arm/shoulder pain, receptive to more movement, doing exercises, yet still numbness in hip. I performed another general session protocol to assess the changes that took place and then focused on hip rotators, quadratus lumborum release as well as worked the rib cage. He reported an even deeper sense of freedom in his range of motion, that he was relaxed, and his hips were a bit better. Again, I reviewed with him the Mentastics® and told him to practice.
Babunona –Dr. Chamal, the Clinical physician recommended Babunona to me. She suffers from sciatica excessive tension in upper body, hip rotators and legs. She has been prescribed pain medication for her condition. I did a general assessment session and in particular mobilized both legs (around the clock) etc. As she relaxed and became aware of the unconscious holding in her hips and legs, her ROM in the left hip increased 30-40%. Gate analysis showed she is walking on outsides of feet, in particular the left foot. I instructed her to redistribute her weight evenly throughout her feet as she walked and to walk with softer )slightly bent) knees. Also shifting weight while sitting (to mobilize rib cage) while she worked and while standing. She became playful and more fluid as we explored what comfortable movement was available to her. After session, she reported no more sciatic pain.
Notes Before Session:
Walking – stiffness in legs Pain L leg only, After tsunami getting much worse
Sitting making coconut leaf weavings for roofing – 1-2 hrs duration at a time
No pain when sitting but when standing and walking
Taking pain killers (not muscle relaxers) for sciatica and occasional shoulder pain
A special day for the Children at Yayawatta Village
After learning that my partner Jen was and artist, Lexia, the village manager, asked her if she would conduct some art/drawing classes for the kids. Her answer was an emphatic 'Yes." She picked up supplies for around 13 children and while I was giving sessions, she and the children drew for hours.
March 31st 2007
Sessions:
Kumarini Wickramsuriya – Navajeevana Chairperson – met for a session and to discuss funding needs for physical therapy department.
Dr. Chamal’s Father. While at the hospital observing the breaking of the wall for the sterilizer, Dr. Chamal asked that I come see his father who has been suffering with low back pain, sciatica for some time. He has undergone two lamanectomy surgeries – I performed an assessment session and found his hip rotators, quadatus lumborum to be chronically contracted. After session he experienced much relief. I reviewed Mentastic® Self Care movements with him (shifting weight with softly bent knees and walking with even weight distribution in the feet)
April 3rd
On my second visit with Dr. Chamal’s Father he explained that he was still experiencing much relief and had pain only when he went into town and was carrying something while walking back up the hill. Otherwise feeling much relief. I continued with my work on his hip rotators, low back and taught more Mentastics®. His ROM in the hips increased and his comfort level with this greater ROM had increased.
Tangalle Hospital – made formal invitation to Dr. Karunaratne and his colleagues to attend The Trager® workshop at Navajeevana on Apriil 7th and 8th. I was amazed at the cue in the waiting room. There must have been 70 or 80 people waiting. Dr. Chamal had mentioned to me that 75% of patients he sees are suffering from pain (I didn’t get a confirmation of the origin(s) of the pain but my sense is that much of it is related to muscular tension, lack of body awareness and the demanding lifestyles of many rural fisherman, farmers and laborers)
Yayawatta Clinic
Note: Jen and I Saw Babunona on path to village….she was smiling and said “hondai” meaning “good” and still “no pain” as she explained. I actually didn't see her until my last day more than three weeks later.
Mr. Ramasinghe was recommend to me by Dr. Chamal. He has been suffering from Parkinson’s for the past three years and back pain for the past year. He also experiences painful restless leg syndrome during the night which interrupts his sleep. He had fallen from a bike and according to him, the trembling in his hands seemed to have started about a year later. He had extremely restricted neck and arm ROM, trapezius and mid back were also very tight. His gate was shallow and unstable and both hands were trembling considerably. He tapped his right hand against his thigh vigorously to "stabilize" it (the tremors).
Interestingly, this activity seemed to be exacerbated when I asked him questions and he began speaking. I did and assessment protocol with the intent on relaxing him first. By the session’s end only his left fingers were active intermittently. He expressed that he felt very relaxed and he had no pain. We practiced Mentastic’s® for his balance (shifting weight) with soft, slightly bent knees and walking to provide him with more stability. His gate had already improved, was more open and fluid and according to his comments he was aware of this change.
Gunawathi – (Lexia present) - chronic neck and shoulder pain, left arm, legs and back…..stress from family/domestic abuse….husband left and stole stuff (affair)…. – emotionally charged. Just touch…holding….She was very upset and the session ended with her having an emotional release. She was very conscientious about having a man work with her and the other village women peered in to the treatment room with curiousity This underscored the need for a female therapist to work in the field as well because of the social implications that exist in this context. As a note, it is understood that Rehabilitation Centers and Hospitals that men will be providing services. Often the entire family travels with patient to the clinic for support. (As a note, I've been training Ms. Erandika at NJ since last year who is also undergoing her psychological counseling training. She would be an ideal candidate as a field visit therapist to provide Trager® sessions.)
Madumekhala - is a young girl, age 12 receiving growth hormone therapy for panhypopituitarism through a program funded by Real Medicine. Click here for more information At age 11 she was the height of a 3 year old. I was asked to get a sense of her response to the treatments as well evaluate her for abuse. She was okay with neck work and occasionally crossed her toes as I worked. When I worked on her belly her legs came together a bit more firmly and after some time she become very fidgety and squirmy…I ended it there and asked Lexia who along with her mother was present, to chat with her about the touch and movement and if it was okay. Cultural….Growth hormone therapy vs. abuse as underlying muscular tension guarding patterns?
Mr. Pattisingho – 3rd visit no shoulder pain but still some numbness in left leg. I worked his neck
and shoulders further, integrating ribs, abdomen and pelvis. Also focused on low back, hip rotators
and psoas. We review more walking exercises to improve his gate and over all comfort during carriage.
Visited Chamani, the girl with CP with Lexia and Jen in YYW – her head was shaved because of lice. She was very excited but calmed down considerably and just held me and let herself be held for almost 30 minutes. Very cool.
April – 4th – follow up on sterilizer at hospital
April – 6th – Yayawatta Clinic
Mr. Ramasinghe returned with his family. He entered the clinic smoothly with an even stable gate. Even Dr. Chamal had commented on this. He was tremor free for 3 days. He has suffered from Parkinson’s for 3 years and pain for 1 year. He was visibly happy and had been doing the exercises. There was a significant difference in his capacity to relax and let go. His Hamstrings remain tight and contracted somewhat. During session he experienced little or no tremors, whereas in the first session his hands shook the whole time. He said he felt relaxed and still. Very happy. Invited his wife to watch me work. Scheduled for 11th. Minerva was amazed at his stillness during session. Anchored this feeling state for him by suggesting he recall this stillness often and invite this feeling back. Told him to use his breath to quiet the tremors. He did this successfully several times during our session. His arm ROM is increasing.
Saw Amil (the boy) knee pain from bike injury. Many cuts and scrapes. Gave him a session of loving touch and he totally chilled out. Made some postural suggestions and he was cool with that. I asked how his mother, Sriyawathie Wanigabadu was doing and he said fine – she was doing the exercises.
I saw Mr. Sumathipala Wanigabadu a 47 year old man who had contracted Chikun Gunya two months ago and is now suffering from joint pain. His blood test showed high leukocyte count – his Drs. recommended that he does not do hard work. I recommended a diet of coconut water because of its similarity to blood plasma and the abundance of the in his area, and greens (gotukola) and fresh fruits to cleanse blood and liver. After session he was very happy and pain free. Coming back on Wednesday.
Saturday and Sunday, April 7th & 8th – Second The Intro to Trager® Workshop at Navajeevana
Private Session with Mr. Samantha Udagama on day one. This one on one time smaller group gave me a great opportunity for me to go deeper with Samantha in exploring the work. He performed a session on me as well and I gave him feedback. Click here for workshop summaries.
On day two I also met with Mr. Lakmal, a former Navajeevana therapist now studying Radiography in Kandy. During my afternoon session with him, a construction worker from Navajeevana stopped in because he was suffering from sciatica. After investigating what movement for him was comfortable and which was painful, I gave him a session. I avoided all painful areas and started with neck, shoulders, ribcage, eventually coming to the legs to address the hip rotators, and low back. By the time I reached his “painful” area, there was no pain. I then mobilized his left hip, low back and legs, again without him experiencing any discomfort. After the session he happily reported no pain. Lakmal commented that in physical therapy he would have be instructed to address the area with pain first, rather than highlight what was okay, soft, intact and pain free. He was surprised at the effectiveness of this approach.
April 9th – Navajeevana Mr. Premadasa 5th visit
April 10th - Navajeevana Special Training Session 1
In the morning I trained Mr. Samantha, Mr. Lakmal and Ms. Erandika, a femail physical therapy assistant at Navajeevana. Ms. Erandika trained with me last year and her current academic load in the field of psychological counseling had made it difficult for her to attend the weekend workshops. We set up two special 3 hour sessions for the 10th and 12th while Navajeevana was on New Year’s holiday to review.
I visited Tangalle Hospiital to observe final installation of Sterilizer. Premium had numerous difficulties arise during the diagnostics phase. Failures on chamber pressure, temperature etc. We suggested they return to complete the job and the demonstration for the staff. As a note, both Minerva and I waited nearly 4 hours while Dr. Karunaratne made himself available between patients. This was a very inefficient use of our time. I mentioned to Mr. Madura that it was imperative to have this job completed as soon as possible. In light of the New Year’s holiday, April 13th and 14th, their return visit for the closure and demo was schedule for April 17th.
April 11, 2007 Yayawatta Clinic
Ramasinghe – Subjective – ML: How have your tremors been since our last session? – Rama :Sometimes it is less but unconsciously it returns. ML: Have you used your breath to help relax them? – Rama: not every time but I have done it. ML: Have you practiced walking exercises? – Rama: Yes. ML: Have you been feeling pain your leg/thigh? – Rama: sometimes – still in the night. ML: Better? Or the same? Rama: Much better now. Restless leg syndrome. Improved. Takes meds each month for parkinson’s. Muscle of the calf is where pain starts. Recently had this pain, yesterday from cramping (spasm). I showed him how to relax his calves before throughout the day and before sleeping, much like I do in the session. I gave him a general session to deepen his experience of relaxation and stillness. Only once during the session did he experience minor tremors in the left hand. We placed a towel over his face and mouth to minimize the disturbance of the flies.
April 12th - Navajeevana Special Training Session 2.
(Photographs from this session and other activities through the 18th were corrupted during a transfer to CD and lost.)
Sri Lankan New Year 13th, 14th but no activity through the 16th
April 17th
Sterilizer Visit. Minerva, Dr. Karunaratne and I set aside Tuesday for the demo. Premium did not call Dr. Karunaratne to tell him they were not coming today. Minerva spent the morning and early afternoon at the hospital and I scheduled no activity for the day to be available at any time for their visit. Again, this was a waste of valuable time. Premium did not even make an effort in good faith to contact us so that our time could have been better spent.
April 18th - sterilizer demonstration. We arrived at 10am and the premium techs were running the set up diagnostics which were completed without incident. We had to wait until 12 pm until some nurses were free to attend. Dr. Karunaratne had a very busy surgery schedule this day because of leaving the previous day open for premium. He was unable to attend the demonstration. However around 11:30 Minerva and I met with him and he reviewed the operation manual with me and he seemed to understand the functioning of the unit well. He also had a number of questions for the techs. The demo was in Sinhala so I could not comment on the presentation. Minerva said it was well done and the nurses were visibly following the demo with full understanding.
April 19th – Yayawatta Clinic
Ramasinghe – Subjective – ML: Have you felt more comfortable at home.? Rama: Yes, sometimes. Restless leg-Less cramping in the night. It is very rare now. ML: Have you been doing Mentastics® at home? Rama: Not daily, but sometimes. (when he answers the tremors increase) ML: How much improvement after these three sessions? Rama: 50-60 %. Tremor and Pain relief w/ exercise.
ML: Would like more treatments. Rama: Yes. Wanted some leg work today. In morning he had some stiffness in legs; put ointment on them.
Walks very smoothly without tremors. He notices the difference in his walking. Much more stable in walking and in getting onto the table. (climbed right up on stoop and sat down without using hand for bracing. One gesture. After session his legs are pain free. Said they are “easy” feeling. Hands do not tremor throughout the treatment. Still however when he is explaining something he has spasms in his hands. A tapping of the right hand on hip. Questioning exacerbates this reaction.
Shoulders more open…did Mentastics® for arms…greater range of motion…..happy….walking gliding..i have him lift sternum with breath and shift gaze to further point on horizon to help correct his slumping posture while walking. He gave me a great big hug and when he leaves he move very quickly, with a stride, not hesitant actually forgot his shoes. Coming back up the hill his gait had such depth and stride. Minerva – “He is moving so fast”
April 21st – Yayawatta Clinic - Last Day.
At the news of my last day at the clinic, almost everyone I had worked with came. We all shared some movement, smiles and I then gave everyone a session. Even a new gentleman showed up but he left by the time I was ready for him.
Again, I'm grateful for the help of Minerva and the local village staff pictured here. Together we accomplished a great deal and learned of the impact that field visits providing Movement Education and Trager had on the well being of many suffering of chronic conditions that were not successfully treated by conventional, allopathic approaches.
Madumekala – Third visit –How do you feel? Fine. Any discomfort associated with Growth? No. During session she was fine with touch and could let go. Seemed distracted and would rather go play with friends. Worked for about 10 minutes and she was fine and happy afterwards. Still some patterns in neck, legs etc. but nothing I would associate with abuse.
Madumekala has grown considerably as a result of RMF's intervention and support. Pictured here with Minerva, it is evident that the loving care being accompanying this support has changed her life.
Mr. Ramasinghe – When Jen and I arrived at the clinic at 8:30am, Rama was sitting with hands and legs still. No tremors at all.
Do you still have stiffness in the calf? Not every time , only sometimes once or twice during the day. How do you feel now? He feels easy and not so hard. Hands we relaxed within minutes of the session. Hamstrings have really strong extension pattern. When he turns he feels a pain in his leg, but when standing it’s not present. His body tenses when he gets up, he uses too much muscle. Instructed him to shift weight in order to emphasize a light, easy feeling. Walks smoothly and with much ease. Very stable and takes larger steps now.
Babunona – Do you have any pain? No.( first visit was for sciatic pain) and I didn't see her until now.
How long have you had sciatic pain? Since before the tsunami. Takes pain meds, but through Mentastics® has felt improvement of 70-80%. She was really happy about this. And the only reason she showed today was to say thank you and good bye. I had her lay face down this time because of her sarong and the holding patterns in her legs attached with the social stigma of having a man touch them. Did new moves on arms. Lots of jiggling. She moved a bit and needed to be reminded to relax quite often. Toward the end she got a lot softer and could let go Fell asleep by the end.
Here she is pictured with Jen. After the session she gave us both hugs but in particular she really grabbed Jen and held her very close and intensely for some time. Her appreciation for Jen's presence was palpable. It was a very emotional moment.
Mr. Pattisingho- How have you been? Still has stiffness in hip- it travels up the arm. His arm feels ok now. He has had pain for more than six years. Feels 50+ % improvement since his first treatment. Has had a bone graft from hip, (maybe they hit a nerve?) This area is stiff, not painful. Sometimes he can’t feel his arm as well. During session, he got some feeling back but still has stiffness in hip. Has a really deep holding pattern in left leg but with no pain. Used weighing and gentle traction in left leg to encourage some release, but he is completely unaware of his holding. Also used soft jiggling movement which made a big difference. He finally let his legs drop out to the sides. Got nice and bouncy by the end. When he stands, he feels numbness in hip, and he puts weight in his heels. Showed him to shift weight in hips in opposite direction and there was an adjustment in his spine. Minerva and I both heard the “pop.” There was no pain associated with this. Had him walk heel to toe and with soft knees so he doesn’t contract gluteals to help release the hip tension and perhaps impact the numbness he's been experiencing.
Mrs. Wanigabadu – how is swelling in your left arm? Little pain. Less than before, but sometimes she can’t use that hand at all (i.e. getting onto bus, etc). When she does the Mentastics®, she feels much better. Worked on neck, shoulders, and arms. She was holding a lot and lifting in the injured arm, but she was unaware if it. Let go after some time. Her injury is from tsunami (things hitting inside the elbow joint). She doesn’t fear the water, she just has no interest in seeing it. She was pinned down by debris on her arm. She is not afraid of the sea but does not want to see it again. Emotional underpinning to the pain and swelling? Perhaps? She is feeling considerably better and through relaxation is able to reduce the pain. The swelling is no longer present.
Amil showed up to say goodbye. He had gotten his hair cut and seemed to be taking better care of himself.
New Guy – Carolis Ekanayaka – 74 yrs old – back pain associated with bloating from gas. Knee pain. Gardening. Not tsunami affected. He left before I could work on him.
Closing Statement:
I cannot put into words the deep sense of gratitude I feel for Dr. Milton Trager, his life's work and it capacity to address such a wide range of conditions. His contribution of "raising the stature of touch to a language," as Deane Juhan puts it, cannot be over emphasized as central component of the efficacy of this work. Milton always said there was something beyond mere relaxation. And this was peace. Through the meditative state cultivated by Mentastics® while I worked, I was able to impart this peace, this feeling, and facilitate for these patients their natural next step in the healing process. The results were dramatic. Please click here for the Navajeevana Activity Summary and Clinical Study.
Below is my activity summary for Sri Lanka March15th- April 24th. Our decision to follow through on our second training after raising only the minimum to cover expenses for a six week trip including airfare, came literally three weeks prior to departure. A lapse in our commitment to conduct more training in Sri Lanka was just not an option. It is my heart felt belief that this decision to maintain continuity of this program was essential for its long term benefit and impact.
Our initiative was a huge success, accomplishing far more than intended and setting in motion future growth of our programs there, however, I feel that a greater optimization of my time would have been possible had we had adequate funding to plan my visit well in advance.
Underscoring the need for more support was the difficulty for some regional therapists interested in the trainings to rearrange their schedules to attend on such short notice. Additionally, many of the patients who would have benefited from sessions were not informed of my availability. At the very least, a two to three fold leverage of my training time may have been possible resulting in more educated therapists and subsequently hundreds more patients receiving enhanced care throughout the southern province.
Despite these constraints, the enthusiasm of the Navajeevana's administration and staff at our decision to come, coupled with the efficiency of Real Medicine's Sri Lankan staff clearly made best use of my time.
Real Medicine Team Whole Health Signed Activity Verification Documents
We are deeply grateful to those who supported this effort. Your contributions came at a critical time for this humanitarian aid project and ensured its success and its future.
For a quick summary of our accomplishments please see the entry on the "What's New Page" by clicking here.
Here we go......
BodyWorkers Without Borders/Real Medicine Team Whole Health enhance physical therapy treatment protocols and highlight the need for ongoing Movement Education as a primary treatment option for chronic muscle pain and functional limitation due to PTS disorder, Parkinson's Disease, Ankylosing Spondylitis, Sciatica, Compensatory responses to injury and abuse trauma.
Getting There and the first couple of day...
After being rerouted from London to Mumbai and then to Columbo, Jen and I arrived in Tangalle late on the March 14th. After settling in over the next day, I visited Navajeevana to meet with Kumarini, the founder and now Chairperson as well as meet with Mr. Arunkumar, the head of the Physical Therapy department to discuss coordinating my time there. We had a brief meeting to arrange time the following week to plan our schedule. I then went to the PT department to visit with my friends, Mr. Samantha Udagama and Mr. Gamani whom I met and trained with last year.
On Friday March 16th, Kelly Prentice arrived to do research for her article for the AMTA's Massage therapy Journal
Saturday Evening, March 17th, We met with Martina Fuchs MD, and Dr. Rubina Mumtaz , RMF coordinator from Pakistan along with 20 others in Sri Lanka who are participating in Real Medicine activities in the southern province. We all shared a similar vision to serve and were grateful for the vehicle of Real Medicine that has brought us together.
Monday March 19th we were picked up early by the RMF van and made a quick stop at Navajeevana so Martina and Kumarini could meet to perhaps provide much needed services to one another. It turned out that Navajeevana can provide the Psychological Services and outpatient Physical Therapy need at Real Medicine installations. Kumarini also spoke of their need for funding for a Head Physical Therapist which is now being investigated by Kelly and I at Good Shepherd Rehabilitation Hospital in Allentown, PA. Upon our return we met with the VP of rehabilitation services to discuss this possibility. For more on this latter story, please click here.After visiting with Navajeevana we were taken to two preschools supported by RMF where we were greeted with flowers and then we went to Tangalle Hospital to follow up on the installation of the water clay sterilizer provided by Direct Relief International at the request of Dr. Fuchs.
Below is a copy of the first email report I provided to Martina. Subsequent updates were done over the phone as there was too much activity to report and summarize in a timely manner. I'm grateful for the support of Minerva Fernando, coordinator for RMF in Sri Lanka. I am also thankful for my trusted Tuk Tuk driver Prasad, and friend Sarath who loaned me his motorcycle pictured here in Yayawatta village so I had complete flexibility and means to meet the many demands of each day. Dear Martina:
On Friday afternoon, March 23rd, 2007, we, (Kelly Prentice, Jen, and Virginia (the RN I spoke to you about and I) were taken by Minerva to the Yayawatta Village. There we were greeted with smiles, flowers and the warm welcome of Sri Lanka we have come to know so well.Our arrival was well coordinated by Minerva who had assembled not only the children you had mentioned but also many other people of the village and surrounding area with ailments for me to evaluate. After meeting Madumekala and her family, along with some of the other children being cared for by RMF, I met with some of the other men and women who had come to see me. Conditions that were most prevalent were arthritic and painful joints and interestingly, varicosity in the lower extremities of women.
I agreed to return to the clinic when the physician was present to provide sessions and recommendations for those whom I feel would best be served by The The Trager® Approach. For the women with varicose veins I thought perhaps I could schedule some time to work with them as a group to teach them some Mentastics® self care movement exercises to reduce the tension in their hips, legs and feet to help alleviate or relieve the pain associated with this condition. (Varicose Veins are contraindicated with The Trager® .) After giving the foods and supplies to the children sponsored by Real Medicine, we took a walk through the village with Lexia to visit with some of the residents who could not make it to the clinic. We visited a young girl with Cerebral Palsy named Chamani and an elderly couple with chronic pain related to inflamed joints and muscle tension. When I visit later this week to work in the clinic, I will make some time to see these patients.
I wanted to point out how well Minerva worked with the clinic staff and Lexia, the Yayawatta village manager, to make a delightful yet productive afternoon visit. Clearly the people of the villages have a strong connection with Minerva and respect both her commitment to being the voice of their needs and the liaison for fulfilling them. It is evident that she works very hard to maintain a strong presence and be an efficient and reliable representative of the Real Medicine Mission.
I'll look forward to returning to the clinic to work with the patients and will provide brief reports early next week.
Saturday and Sunday March 24th and 25th 2007
Navajeevana Rehabilitation Center - The Trager® Workshop.
Over the course of last week, I had an opportunity to give treatments to members of Navajeevana's Physio and Occupational therapy staff. This past weekend, March 24th and 25th I conducted a two day training for 4 members of their staff, and three others. This training included self care and nutritional modules as well as a review of a the basic treatment protocol of The Trager® Approach based on the fundamental principals of the approach. For a more comprehensive report on this training and the training sessions conducted April 7th, 8th, 10th and 12th please click here.All members participated with much enthusiasm and were very quick to pick up the techniques reviewed. We will be reviewing clinical applications throughout the coming weeks and there is a second training scheduled for April 7th and 8th. I have also selected two patients whom I'll be treating at least twice weekly with The Trager® Approach. I've arranged to pay for their transportation to Navajeevana so they may participate in a more in depth case study over the next 3-4 weeks as suggested by Arun, the head physio at NJ. I'll update you on their conditions as we get underway tomorrow, Wednesday the 28th. I also hope to connect with Claudia at GTZ this week or next. I now have a queue of others who are interested in sessions.
Today, March 27th, 20007 Minerva and I visited the Tamil Montessori Pre-school in Dickwella. Again it was a pleasant and well coordinated event and provided another example of Minerva's hard work to optimize
the Real Medicine mission. How beautiful it was to discover that this was the first seed that Minerva planted on behalf of Real Medicine. Mr. M.M. Imthiyas, the director was an inspiring soul as well with the community’s best interest very much at heart. I couldn't help but feel much gratitude to everyone for sharing with me the blossoming work of Real Medicine in Sri Lanka. It is so moving to see so many smiling faces and to be part of such compassionate efforts to support these communities in need.
Psychological Services
I’ve met with both Kumarini and Christine of Navajeevana (NJ) to follow up on the discussion we had at our group meeting on March 19th regarding NJ providing Psychological and Physiotherapy services to RMF’s clinic at Yayawatta Village. Madame Christine will be in charge of this. She was busy through the time I left and unable to meet to initiate the process. I wrote a letter to her reviewing the details and introducing Minerva Fernando as the RMF contact to arrange services. Please see the attached letter. Minerva is very familiar with the needs of the Yayawatta community and will be able to facilitate this process successfully. Additionally, I’ve provided the Navajeevana therapists with my notes from my clinical sessions along with recommendations to support their participation at Yayawatta when they begin field visit activities there. They are very much looking forward to working with RMF and helping the village.
Note: Below is a continuation of the above report summarized by date. Interpretation was performed by RMF Sri Lanka Coordinator Minerva Fernando. All Subjective patient feedback has been provided through her interpretation. * All patient conditions were addressed with The Trager® Approach and Mentatstics® Movement Education. While the following is listed by date as a chronicle of my RMF clinic activity, I've provided a individual Case Summaries for Patients from Navajeevana and Yayawatta here. These are my actual notes at typed or scribed during my clinic time. I've added some photos from each session as well. I've seen most of the patients multiple times during the course of my trip. Please read through to see their progress.
Wednesday – March 28th 2007
Yayawatta Clinic
I met with Mr. Pattisingho and older man who was in a pretty severe bicycle accident which left him with a broken arm requiring extensive surgery. He explained that he had a broken left humerous and has pins in his arm – bone graft from left hip (numbness now in left hip and left rib cage)
I noticed the L clavical severely misaligned. He explained that surgery at the time would have threatened his life.
He complains of pain in neck, shoulder and upper arm as well as the numbness previously mentioned.
I Performed Trager® on neck, shoulders arms, hips, ribcage to facilitate release of muscle holding. Heavily restrictive. deeply seated muscular patterns throughout shoulder girdle, ie. in trapezius, deltoid, scapular region.
After session, I reviewed with him a number of Mentastics® (self care movement/awareness exercises) for neck, shoulders, arms, and hips and encouraged him to practice these a couple times each day.
Post session he felt freed of shoulder and neck pain but still had numbness in hip. Rib cage had slight sensation.
Patient 2
Summary: I met with the mother of a Young Girl who, as she explained has no memory of instructions or any action…always receiving instructions but having no response or memory of such. Perhaps she is autistic. At first she was frightened to meet me but then she let me hold her hand for some time. Still a bit nervous. Explained to mother that there was nothing I could do but would suggest NJ Psychological support (she has been to NJ) – they said she needs socialization
Patient 3
Summary: I met with the mother of a deaf boy who brought me all of the diagnostic sheets for her son which state that her son is completely deaf. Even a hearing aid would not be of benefit. – actually current aid is not helping. The boy is taking signing classes in Matara. I encouraged his mother to learn how to sign to support her son’s progress and ability to communicate.
Mrs. Wanigabadu (Amil’s Mother) – swollen left elbow – complains of pain. She had been pinned down by debris on her arm during the tsunami. She mentioned "I am not afraid of the sea however, I don't ever want to see it again."
Excessive muscle holding pattern/tension in trapezious, bicept etc. I addressed her neck, both shoulders, arms and ribcage. This facilitated much relaxation. Instructed her in Mentastics® movement exercises to maintain this free feeling. She reported no pain at close of session.
March 29th 2007 – cannot find notes from this day. My apologies. I wrote them on the back of a piece of paper that was then misplaced.
March 30th - RMF Yayawatta Clinic
Amil Wanigabadu – I met Amil on my first visit to the clinic. His mother said he was a “troubled” or problem child, always hyper and fighting. He seems stressed, apparently picks at cuts (his legs are a mess). Minerva explained that he is hit on the back in punishment for his behavior. Amil and I had an immediate connection on our first visit. As we toured the village he walked with me holding my hand as friends in Sri Lanka often do. I gave Amil a session to give him the feeling of “what is peaceful, relaxed, easy, soft.” After the session, I encouraged him to remember this feeling; that this peaceful place he was experiencing was inside of him and only a thought away. He seemed a bit perplexed that a stranger would have taken interest in him but was very happy to receive the session.
Mrs. Wanigabadu (Amil’s Mother) – 2nd visit - arm swelling, much improved about 80% less, no pain, very relaxed. My sense is that this pain and swelling was PTS related to her traumatic experience in the Tsunami.
Mr. Pattisingho – 2nd visit - Reports no more arm/shoulder pain, receptive to more movement, doing exercises, yet still numbness in hip. I performed another general session protocol to assess the changes that took place and then focused on hip rotators, quadratus lumborum release as well as worked the rib cage. He reported an even deeper sense of freedom in his range of motion, that he was relaxed, and his hips were a bit better. Again, I reviewed with him the Mentastics® and told him to practice.
Babunona –Dr. Chamal, the Clinical physician recommended Babunona to me. She suffers from sciatica excessive tension in upper body, hip rotators and legs. She has been prescribed pain medication for her condition. I did a general assessment session and in particular mobilized both legs (around the clock) etc. As she relaxed and became aware of the unconscious holding in her hips and legs, her ROM in the left hip increased 30-40%. Gate analysis showed she is walking on outsides of feet, in particular the left foot. I instructed her to redistribute her weight evenly throughout her feet as she walked and to walk with softer )slightly bent) knees. Also shifting weight while sitting (to mobilize rib cage) while she worked and while standing. She became playful and more fluid as we explored what comfortable movement was available to her. After session, she reported no more sciatic pain.
Notes Before Session:
Walking – stiffness in legs Pain L leg only, After tsunami getting much worse
Sitting making coconut leaf weavings for roofing – 1-2 hrs duration at a time
No pain when sitting but when standing and walking
Taking pain killers (not muscle relaxers) for sciatica and occasional shoulder pain
A special day for the Children at Yayawatta Village
After learning that my partner Jen was and artist, Lexia, the village manager, asked her if she would conduct some art/drawing classes for the kids. Her answer was an emphatic 'Yes." She picked up supplies for around 13 children and while I was giving sessions, she and the children drew for hours.
March 31st 2007
Sessions:
Kumarini Wickramsuriya – Navajeevana Chairperson – met for a session and to discuss funding needs for physical therapy department.
Dr. Chamal’s Father. While at the hospital observing the breaking of the wall for the sterilizer, Dr. Chamal asked that I come see his father who has been suffering with low back pain, sciatica for some time. He has undergone two lamanectomy surgeries – I performed an assessment session and found his hip rotators, quadatus lumborum to be chronically contracted. After session he experienced much relief. I reviewed Mentastic® Self Care movements with him (shifting weight with softly bent knees and walking with even weight distribution in the feet)
April 3rd
On my second visit with Dr. Chamal’s Father he explained that he was still experiencing much relief and had pain only when he went into town and was carrying something while walking back up the hill. Otherwise feeling much relief. I continued with my work on his hip rotators, low back and taught more Mentastics®. His ROM in the hips increased and his comfort level with this greater ROM had increased.
Tangalle Hospital – made formal invitation to Dr. Karunaratne and his colleagues to attend The Trager® workshop at Navajeevana on Apriil 7th and 8th. I was amazed at the cue in the waiting room. There must have been 70 or 80 people waiting. Dr. Chamal had mentioned to me that 75% of patients he sees are suffering from pain (I didn’t get a confirmation of the origin(s) of the pain but my sense is that much of it is related to muscular tension, lack of body awareness and the demanding lifestyles of many rural fisherman, farmers and laborers)
Yayawatta Clinic
Note: Jen and I Saw Babunona on path to village….she was smiling and said “hondai” meaning “good” and still “no pain” as she explained. I actually didn't see her until my last day more than three weeks later.
Mr. Ramasinghe was recommend to me by Dr. Chamal. He has been suffering from Parkinson’s for the past three years and back pain for the past year. He also experiences painful restless leg syndrome during the night which interrupts his sleep. He had fallen from a bike and according to him, the trembling in his hands seemed to have started about a year later. He had extremely restricted neck and arm ROM, trapezius and mid back were also very tight. His gate was shallow and unstable and both hands were trembling considerably. He tapped his right hand against his thigh vigorously to "stabilize" it (the tremors).
Interestingly, this activity seemed to be exacerbated when I asked him questions and he began speaking. I did and assessment protocol with the intent on relaxing him first. By the session’s end only his left fingers were active intermittently. He expressed that he felt very relaxed and he had no pain. We practiced Mentastic’s® for his balance (shifting weight) with soft, slightly bent knees and walking to provide him with more stability. His gate had already improved, was more open and fluid and according to his comments he was aware of this change.
Gunawathi – (Lexia present) - chronic neck and shoulder pain, left arm, legs and back…..stress from family/domestic abuse….husband left and stole stuff (affair)…. – emotionally charged. Just touch…holding….She was very upset and the session ended with her having an emotional release. She was very conscientious about having a man work with her and the other village women peered in to the treatment room with curiousity This underscored the need for a female therapist to work in the field as well because of the social implications that exist in this context. As a note, it is understood that Rehabilitation Centers and Hospitals that men will be providing services. Often the entire family travels with patient to the clinic for support. (As a note, I've been training Ms. Erandika at NJ since last year who is also undergoing her psychological counseling training. She would be an ideal candidate as a field visit therapist to provide Trager® sessions.)
Madumekhala - is a young girl, age 12 receiving growth hormone therapy for panhypopituitarism through a program funded by Real Medicine. Click here for more information At age 11 she was the height of a 3 year old. I was asked to get a sense of her response to the treatments as well evaluate her for abuse. She was okay with neck work and occasionally crossed her toes as I worked. When I worked on her belly her legs came together a bit more firmly and after some time she become very fidgety and squirmy…I ended it there and asked Lexia who along with her mother was present, to chat with her about the touch and movement and if it was okay. Cultural….Growth hormone therapy vs. abuse as underlying muscular tension guarding patterns? Mr. Pattisingho – 3rd visit no shoulder pain but still some numbness in left leg. I worked his neck
and shoulders further, integrating ribs, abdomen and pelvis. Also focused on low back, hip rotators
and psoas. We review more walking exercises to improve his gate and over all comfort during carriage.
Visited Chamani, the girl with CP with Lexia and Jen in YYW – her head was shaved because of lice. She was very excited but calmed down considerably and just held me and let herself be held for almost 30 minutes. Very cool.
April – 4th – follow up on sterilizer at hospital
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April – 6th – Yayawatta Clinic
Mr. Ramasinghe returned with his family. He entered the clinic smoothly with an even stable gate. Even Dr. Chamal had commented on this. He was tremor free for 3 days. He has suffered from Parkinson’s for 3 years and pain for 1 year. He was visibly happy and had been doing the exercises. There was a significant difference in his capacity to relax and let go. His Hamstrings remain tight and contracted somewhat. During session he experienced little or no tremors, whereas in the first session his hands shook the whole time. He said he felt relaxed and still. Very happy. Invited his wife to watch me work. Scheduled for 11th. Minerva was amazed at his stillness during session. Anchored this feeling state for him by suggesting he recall this stillness often and invite this feeling back. Told him to use his breath to quiet the tremors. He did this successfully several times during our session. His arm ROM is increasing.
Saw Amil (the boy) knee pain from bike injury. Many cuts and scrapes. Gave him a session of loving touch and he totally chilled out. Made some postural suggestions and he was cool with that. I asked how his mother, Sriyawathie Wanigabadu was doing and he said fine – she was doing the exercises.
I saw Mr. Sumathipala Wanigabadu a 47 year old man who had contracted Chikun Gunya two months ago and is now suffering from joint pain. His blood test showed high leukocyte count – his Drs. recommended that he does not do hard work. I recommended a diet of coconut water because of its similarity to blood plasma and the abundance of the in his area, and greens (gotukola) and fresh fruits to cleanse blood and liver. After session he was very happy and pain free. Coming back on Wednesday.
Saturday and Sunday, April 7th & 8th – Second The Intro to Trager® Workshop at Navajeevana
Private Session with Mr. Samantha Udagama on day one. This one on one time smaller group gave me a great opportunity for me to go deeper with Samantha in exploring the work. He performed a session on me as well and I gave him feedback. Click here for workshop summaries.On day two I also met with Mr. Lakmal, a former Navajeevana therapist now studying Radiography in Kandy. During my afternoon session with him, a construction worker from Navajeevana stopped in because he was suffering from sciatica. After investigating what movement for him was comfortable and which was painful, I gave him a session. I avoided all painful areas and started with neck, shoulders, ribcage, eventually coming to the legs to address the hip rotators, and low back. By the time I reached his “painful” area, there was no pain. I then mobilized his left hip, low back and legs, again without him experiencing any discomfort. After the session he happily reported no pain. Lakmal commented that in physical therapy he would have be instructed to address the area with pain first, rather than highlight what was okay, soft, intact and pain free. He was surprised at the effectiveness of this approach.
April 9th – Navajeevana Mr. Premadasa 5th visit
April 10th - Navajeevana Special Training Session 1
In the morning I trained Mr. Samantha, Mr. Lakmal and Ms. Erandika, a femail physical therapy assistant at Navajeevana. Ms. Erandika trained with me last year and her current academic load in the field of psychological counseling had made it difficult for her to attend the weekend workshops. We set up two special 3 hour sessions for the 10th and 12th while Navajeevana was on New Year’s holiday to review.
I visited Tangalle Hospiital to observe final installation of Sterilizer. Premium had numerous difficulties arise during the diagnostics phase. Failures on chamber pressure, temperature etc. We suggested they return to complete the job and the demonstration for the staff. As a note, both Minerva and I waited nearly 4 hours while Dr. Karunaratne made himself available between patients. This was a very inefficient use of our time. I mentioned to Mr. Madura that it was imperative to have this job completed as soon as possible. In light of the New Year’s holiday, April 13th and 14th, their return visit for the closure and demo was schedule for April 17th.
April 11, 2007 Yayawatta Clinic
Ramasinghe – Subjective – ML: How have your tremors been since our last session? – Rama :Sometimes it is less but unconsciously it returns. ML: Have you used your breath to help relax them? – Rama: not every time but I have done it. ML: Have you practiced walking exercises? – Rama: Yes. ML: Have you been feeling pain your leg/thigh? – Rama: sometimes – still in the night. ML: Better? Or the same? Rama: Much better now. Restless leg syndrome. Improved. Takes meds each month for parkinson’s. Muscle of the calf is where pain starts. Recently had this pain, yesterday from cramping (spasm). I showed him how to relax his calves before throughout the day and before sleeping, much like I do in the session. I gave him a general session to deepen his experience of relaxation and stillness. Only once during the session did he experience minor tremors in the left hand. We placed a towel over his face and mouth to minimize the disturbance of the flies.April 12th - Navajeevana Special Training Session 2.
(Photographs from this session and other activities through the 18th were corrupted during a transfer to CD and lost.)
Sri Lankan New Year 13th, 14th but no activity through the 16th
April 17th
Sterilizer Visit. Minerva, Dr. Karunaratne and I set aside Tuesday for the demo. Premium did not call Dr. Karunaratne to tell him they were not coming today. Minerva spent the morning and early afternoon at the hospital and I scheduled no activity for the day to be available at any time for their visit. Again, this was a waste of valuable time. Premium did not even make an effort in good faith to contact us so that our time could have been better spent.
April 18th - sterilizer demonstration. We arrived at 10am and the premium techs were running the set up diagnostics which were completed without incident. We had to wait until 12 pm until some nurses were free to attend. Dr. Karunaratne had a very busy surgery schedule this day because of leaving the previous day open for premium. He was unable to attend the demonstration. However around 11:30 Minerva and I met with him and he reviewed the operation manual with me and he seemed to understand the functioning of the unit well. He also had a number of questions for the techs. The demo was in Sinhala so I could not comment on the presentation. Minerva said it was well done and the nurses were visibly following the demo with full understanding.
April 19th – Yayawatta Clinic
Ramasinghe – Subjective – ML: Have you felt more comfortable at home.? Rama: Yes, sometimes. Restless leg-Less cramping in the night. It is very rare now. ML: Have you been doing Mentastics® at home? Rama: Not daily, but sometimes. (when he answers the tremors increase) ML: How much improvement after these three sessions? Rama: 50-60 %. Tremor and Pain relief w/ exercise.
ML: Would like more treatments. Rama: Yes. Wanted some leg work today. In morning he had some stiffness in legs; put ointment on them.
Walks very smoothly without tremors. He notices the difference in his walking. Much more stable in walking and in getting onto the table. (climbed right up on stoop and sat down without using hand for bracing. One gesture. After session his legs are pain free. Said they are “easy” feeling. Hands do not tremor throughout the treatment. Still however when he is explaining something he has spasms in his hands. A tapping of the right hand on hip. Questioning exacerbates this reaction.
Shoulders more open…did Mentastics® for arms…greater range of motion…..happy….walking gliding..i have him lift sternum with breath and shift gaze to further point on horizon to help correct his slumping posture while walking. He gave me a great big hug and when he leaves he move very quickly, with a stride, not hesitant actually forgot his shoes. Coming back up the hill his gait had such depth and stride. Minerva – “He is moving so fast”
April 21st – Yayawatta Clinic - Last Day.
At the news of my last day at the clinic, almost everyone I had worked with came. We all shared some movement, smiles and I then gave everyone a session. Even a new gentleman showed up but he left by the time I was ready for him.Again, I'm grateful for the help of Minerva and the local village staff pictured here. Together we accomplished a great deal and learned of the impact that field visits providing Movement Education and Trager had on the well being of many suffering of chronic conditions that were not successfully treated by conventional, allopathic approaches.Madumekala – Third visit –How do you feel? Fine. Any discomfort associated with Growth? No. During session she was fine with touch and could let go. Seemed distracted and would rather go play with friends. Worked for about 10 minutes and she was fine and happy afterwards. Still some patterns in neck, legs etc. but nothing I would associate with abuse. Madumekala has grown considerably as a result of RMF's intervention and support. Pictured here with Minerva, it is evident that the loving care being accompanying this support has changed her life. Mr. Ramasinghe – When Jen and I arrived at the clinic at 8:30am, Rama was sitting with hands and legs still. No tremors at all.
Do you still have stiffness in the calf? Not every time , only sometimes once or twice during the day. How do you feel now? He feels easy and not so hard. Hands we relaxed within minutes of the session. Hamstrings have really strong extension pattern. When he turns he feels a pain in his leg, but when standing it’s not present. His body tenses when he gets up, he uses too much muscle. Instructed him to shift weight in order to emphasize a light, easy feeling. Walks smoothly and with much ease. Very stable and takes larger steps now.
Babunona – Do you have any pain? No.( first visit was for sciatic pain) and I didn't see her until now.How long have you had sciatic pain? Since before the tsunami. Takes pain meds, but through Mentastics® has felt improvement of 70-80%. She was really happy about this. And the only reason she showed today was to say thank you and good bye. I had her lay face down this time because of her sarong and the holding patterns in her legs attached with the social stigma of having a man touch them. Did new moves on arms. Lots of jiggling. She moved a bit and needed to be reminded to relax quite often. Toward the end she got a lot softer and could let go Fell asleep by the end.
Here she is pictured with Jen. After the session she gave us both hugs but in particular she really grabbed Jen and held her very close and intensely for some time. Her appreciation for Jen's presence was palpable. It was a very emotional moment.
Mr. Pattisingho- How have you been? Still has stiffness in hip- it travels up the arm. His arm feels ok now. He has had pain for more than six years. Feels 50+ % improvement since his first treatment. Has had a bone graft from hip, (maybe they hit a nerve?) This area is stiff, not painful. Sometimes he can’t feel his arm as well. During session, he got some feeling back but still has stiffness in hip. Has a really deep holding pattern in left leg but with no pain. Used weighing and gentle traction in left leg to encourage some release, but he is completely unaware of his holding. Also used soft jiggling movement which made a big difference. He finally let his legs drop out to the sides. Got nice and bouncy by the end. When he stands, he feels numbness in hip, and he puts weight in his heels. Showed him to shift weight in hips in opposite direction and there was an adjustment in his spine. Minerva and I both heard the “pop.” There was no pain associated with this. Had him walk heel to toe and with soft knees so he doesn’t contract gluteals to help release the hip tension and perhaps impact the numbness he's been experiencing.
Mrs. Wanigabadu – how is swelling in your left arm? Little pain. Less than before, but sometimes she can’t use that hand at all (i.e. getting onto bus, etc). When she does the Mentastics®, she feels much better. Worked on neck, shoulders, and arms. She was holding a lot and lifting in the injured arm, but she was unaware if it. Let go after some time. Her injury is from tsunami (things hitting inside the elbow joint). She doesn’t fear the water, she just has no interest in seeing it. She was pinned down by debris on her arm. She is not afraid of the sea but does not want to see it again. Emotional underpinning to the pain and swelling? Perhaps? She is feeling considerably better and through relaxation is able to reduce the pain. The swelling is no longer present.
Amil showed up to say goodbye. He had gotten his hair cut and seemed to be taking better care of himself.
New Guy – Carolis Ekanayaka – 74 yrs old – back pain associated with bloating from gas. Knee pain. Gardening. Not tsunami affected. He left before I could work on him.
Closing Statement:
I cannot put into words the deep sense of gratitude I feel for Dr. Milton Trager, his life's work and it capacity to address such a wide range of conditions. His contribution of "raising the stature of touch to a language," as Deane Juhan puts it, cannot be over emphasized as central component of the efficacy of this work. Milton always said there was something beyond mere relaxation. And this was peace. Through the meditative state cultivated by Mentastics® while I worked, I was able to impart this peace, this feeling, and facilitate for these patients their natural next step in the healing process. The results were dramatic. Please click here for the Navajeevana Activity Summary and Clinical Study.