India and South Korea from a PT's view

As some of you know, I am a physical therapist. While we are doing this whole traveling thing I am not able to actually practice much PT. My PRN boss said that I can call her up and get on the schedule for a Saturday if I'm back in Chicago, but other than that, not much work happening for me. That doesn't mean I don't watch people with my PT eyes though.

This is an AFO, it is used for a variety of reasons,
commonly used to prevent toe drag in those with hemiplegia

In India, there are some issues with quality of medical care for those that are less fortunate. In Reliance Greens where we stayed, there was a good hospital and clinic. Most of the people I remember seeing in Reliance Greens with orthopedic/neurologic issues had access to this facility, but I'm not sure there was a PT on staff there. I'm not sure about utilization of PTs outside the United States. Anyway, I saw many people who had clearly either had a stroke or were a hemiparetic  from a brain injury or even cerebral palsy. In the U.S., these people would most likely be in a wheelchair for community mobility, or require a hemi-walker and an Ankle-Foot Orthosis to walk. Even then, I would probably recommend they not walk alone until they were more stable. I saw several people within Reliance Greens walking around on the streets with the characteristic Hemi-plegic walk, no cane or walker and no brace on their foot to keep it from dragging. They compensated in other ways (usually tilting their body to the side away from the involved side in order to hike the hip and clear the toe. On top of that, most were wearing sandals. I would tell a patient to wear good, supportive shoes and not wear sandals because they were a tripping hazard. Thinking about their culture, and the heat, and the bad roads and everything else, I don't know what I would recommend to people here. They seem to walk around just fine. I think most likely they don't have a choice. They can either lay around all day, or get up and walk without the assistive devices and braces. It is scary to watch them, but I have to keep in mind that this is the life they are living every day!

Image credit

From my experience in South Korea, I know that in general they have high quality medical care. Here in Korea, though, it seems that less people use assistive devices and braces as well. First off, on my runs in the mornings, I often come upon people in hospital looking pajamas, some with IV poles, just hanging out or walking down the street or in the grocery store. I'm not sure what the official policy is, but it seems that when you are a patient at a hospital, if you feel well enough to walk around, you can by all means do so. I know for mobilizing patients in some hospitals in the US, they don't even let physical therapists mobilize them when IVs are running. These people are sometimes accompanied by family, but never by a therapist. Right by our grocery store is a spine hospital. I'm not sure what conditions they treat, but I have seen ladies with back braces walking around the grocery store with their IV poles. It blows my mind, but I think if a patient has proven that they can move around that much, they should be able to do what they want. Perhaps in the U.S. it is that once a patient is that mobile, they go home and are followed up with outpatient therapy or they go to a nursing home if they are on IV antibiotics. I'm not sure about length of stay averages in the hospital here vs. U.S.

This is a hemi walker- a little more stable than a cane
for those with hemiplegia

Very much like India, but perhaps even more so because I have a bigger population sample, people with severe movement deficits are walking around without assistive devices. Sometimes it is a little scary. I have seen several with Parkinsonian symptoms (trouble with initiation of movement, and short fast steps) as well as LOTS with hemiplegic looking gaits. Many people smoke here, so I don't know if that has anything to do with me seeing so many people with strokes, or if there are just more out and about. Sometimes I run along a trail that follows the Han River. There are multiple points along the trail where you can join it from the neighborhoods along the river (there is a freeway right by the trail so you have to take designated tunnels to get to the trail itself.) Anyway, my point is while I am running, I see people with horrible looking walks several kilometers away from an entrance to the trail. They are going at a snail's pace and look like they are going to fall over at any moment, yet they are trekking on and getting their exercise in. I think it is amazing. No walkers, no canes, no fancy AFOs or anything. I see more people with shoes on here, but I think it is just cultural and that it is not as hot here. I can't help but ask myself, "When I was in the nursing home, did I underestimate the functional level that my patients could achieve?" I think it is a matter of necessity and motivation in most of these people.

Regardless of functional level, I have to hand it to the Koreans for staying fit their whole life. They eat a relatively healthy diet of rice and meat and veggies, especially the fermented ones that help decrease overall inflammation and lead to a healthy gut. They go on walks every day, and work out on the exercise equipment that is prevalent in every Korean park I have ever been to. There are range of motion exercises to keep shoulder reaching how they should. There are strengthening exercises for arms and legs. There are pieces of equipment that challenge balance. I can't tell you how many older adults I have seen over the past 2 months utilizing this equipment, mostly when I am running. Also, there are lots of mountains around Seoul and I have seen people of all ages climbing them. Good job Koreans!