Ready to Work
A van pulls into the driveway and suddenly, there is a bustle of activity.
Juana reaches for her mother and, together with Sister Dede, lifts her out of the van and sets her into a wheelchair. They forgot to attach the leg rests today, so Juana's eight-year-old daughter holds up her grandmother's legs.
As they roll into the cozy waiting room, Juana is upbeat. “Mama is doing well,” she says. “Estamos listas para trabajar.” We are ready to work.
Juana is not the patient – she is the caregiver – but this appointment is as much for her as anyone.
Two years earlier, Juana’s mother Cesarea suffered a massive stroke – her second – while in the United States visiting her daughter. She was hospitalized and in a coma, but later regained consciousness. Nonetheless, the stroke took its toll, leaving Cesarea with almost no muscle control and limited cognitive function.
Without health insurance, the El Salvadoran woman’s options for care were limited, and she was discharged from the hospital to recover at home with her daughter, Juana.
"Socioeconomic status is the most powerful predictor of disease, disorder, injury and mortality we have." – Tom Boyce, Chief of UCSF’s Division of Developmental Medicine
Suddenly, Juana found herself the mother of four children, provider for the family and full-time caregiver for her ailing mother.
“At that time, Cesarea was barely opening her eyes, and Juana wasn’t sure how to manage the nutrition,” explains Sister Dede. “Her daughter went to our preschool in Maryland and is part of the community there – that’s how we knew her.”
Fortunately, they were able to help find a temporary home for the first three months of Cesarea’s recovery. Since then, she has been in the complete care of her daughter.
“I’ve been over there a couple of times because the feeding tube popped out,” says Sister Dede, explaining that without the ability to swallow she cannot eat. “But through Catholic Charities, we were able to get her a new feeding tube.”
Juana does everything for her mother – purees her food, bathes her, lifts her and cares for her all hours of the day minus those spent working her full-time job (4-11pm daily) cleaning office space. Still, Juana exudes joy.
The recovery has been slow, but there are signs of progress. “She’s much better,” says Juana. “She opens her eyes and smiles now.”
"These little things that for us may not mean a whole lot because we take it for granted mean so much. So it’s more than just physical therapy – it’s love," says Sister Dede.
The Need Was There
Upon first glance, the building doesn’t stand out – there is no sign overhead announcing a physical therapy clinic nor the religious order that lends its space for medical care. Two larger brick row houses are connected by a smaller one, and on the door of the entryway gate is a piece of paper that reads simply “La Clinica: The Clinic.”
The buildings are home to the Little Workers of the Sacred Hearts – a religious community with roots in Southern Italy dedicated to contemplation, education and charity.
I sit down with Sister Dede and ask her how this convent became home to a physical therapy clinic. She launches into the story, full of winds and turns. “I joined the community of Little Workers of the Sacred Hearts in 2001. Being a physician, word got out, and people would come by with medical problems.”
She imagined transforming an unused portion of the house into a medical clinic to serve those who needed care, but did not have insurance and could not afford it.
As this idea began to form in Sister Dede’s head, she was approached by a young, newly trained physical therapist named Katie Drummond.
"I wanted to have a better understanding of the health care field. It is more than just science — it’s building relationships and being able to understand the whole human person."
Katie Drummond, PT, Clinic Co-founder & Volunteer Coordinator, Little Workers of the Sacred Hearts PT Clinic
Katie does not remember her first meeting with Sister Dede, but is told they met when she was about three years old. Sister Dede was doing her residency at Fort Belvoir under a family physician by the name of Dr. Kugler – Katie’s father.
Nearly two decades after that first meeting, Katie had completed her undergraduate degree in behavioral and developmental psychology and a doctorate degree in physical therapy and accepted a job as a PT at the Kennedy Institute – a day school for children with disabilities – just blocks away from the Little Workers' residence.
While at the Kennedy Institute, Katie learned that many of the medical supplies used in a nearby school were destined for the dumpster. She remembers thinking, “There’s got to be a better way.” And so, she reconnected with Sister Dede, hoping to find a home for the discarded supplies.
“She said yes, but come and meet me,” Katie recalls. “She showed me this room that she had. They were just clearing it out, it had been a preschool. They had little tiny toilets and sinks.”
But Sister Dede saw more than a defunct preschool space. “I’d love to be able to turn this into some sort of medical clinic,” she told Katie.
Sister Deidre Byrne (affectionately known as Sister Dede) is a catholic nun, board certified family practitioner and general surgeon, retired army colonel and founder and director of the only pro bono physical therapy clinic in the District of Columbia.
"District-wide, black residents are more than four times as likely as white residents to not have insurance, and Latino residents were the most likely to not have insurance, with more than 17 percent of the population within the city’s borders lacking it." - The Atlantic Monthly
When asked about the origins of the clinic, her answer is straight-forward: “We saw the need was there.”
As clinic director and general surgeon for the Spanish Catholic Center, Sister Dede provides free medical care to the under-served. Her patients are the working poor – often immigrants and refugees – trying to care for their families, but not making quite enough to provide quality health insurance. One of the gaps she recognized – a need for physical therapy.
“That was one of the things they didn’t have enough of – a place to send people with chronic pain syndromes. At the clinic, we take care of stroke victims and people who have suffered injury or trauma, refugees who have been tortured, beaten, thrown in prison.”
“I was fresh out of PT school,” says Katie. “I had talked about pro bono clinics with one of my professors, and she said, ‘It’s a great idea, but get yourself established first. Start to learn from other PTs.’”
But Katie couldn’t deny the pull to help launch the clinic. “I felt like this had to work. It makes so much sense. We have a space, we have sisters to help staff it.”
“I’ll stay,” she told Sister Dede, “but I don’t want to be in charge. I’ll help you get going, and I’ll volunteer.”
Katie soon connected with another, more experienced physical therapist named Alexa Stevens. Together, the two of them shared a passion for using physical therapy to help those who need it most and began assembling a team of volunteers to staff the clinic.
"When I met Sister Dede in 2007, and she told me what she wanted to do, I knew it was what I was suppose to be doing," says Alexa. "I have never regretted it. It’s just part of my lifestyle, so much so that often my kids are with me and my husband comes by."
At the time, Alexa worked with students at George Washington University and was able to bring on board an entire network of students also interested in contributing through pro bono work.
"Something that all of the PTs here have in common is this giving of your whole self, this is why we were all drawn to physical therapy. Meeting other people who are like that – who see this as not a sacrifice, but part of who they are and part of a way of life – it makes it natural and easy to do," explains Katie.
Soon, the clinic had a roster of volunteers and a starting supply of donated materials and equipment. Gradually, the former preschool room transformed into a physical therapy clinic – one where quality care would be free, compassionate, holistic and available to those who need it most.
"You don’t have to go to Haiti or India," says Sister Dede, "if you just look in your own neighborhood, there is healing that can be done."
It's a Lot of Education
Back in the clinic, Alexa comes out and introduces herself. “Let’s get started,” she says to Juana and her mother, leading them back to the physical therapy room.
Two tables line the room, and sunlight streams in through a wall of windows. The room is bright and cheery, but also sparse. Physical therapy bands, balls and other equipment fill the open space.
Alexa pulls up a chair and begins her initial assessment for the PT session – this is Cesarea’s first visit. With a series of questions, she efficiently and adeptly ascertains the patient's full medical history and current needs.
She then turns the questions to Juana: “How do you get her in and out of the chair?”
“I’m not afraid to put her in the chair,” answers Juana. “I carry her… I move the chair closer to the bed. I take her to the shower. I use a spray bottle and massage her head. She looks happy when I do that.”
Alexa suggests they begin by practicing how to transition Cesarea from her wheelchair to the bed.
“Quieres caminar, verdad que si,” Juana says to her mom. “You want to walk, right?” translates the interpreter.
“We’re not going to walk today… but we’re going to see how she gets from her chair to the bed,” Alexa responds, gently managing expectations. “Her left side is the strongest, so we’re going to start on the left,” Alexa explains as she instructs Juana on how to properly transfer her mother to the bed without injuring herself.
Once in the bed, Alexa asks Cesarea to try moving her foot. A few moments later she follows up, “can you move your toe?” I watch as her feet and toes remain completely still – no detectable movement.
Alexa reviews some stretches and activities that Juana can do with her mother at home. She reminds her to make sure she stands on her right side when she speaks to try and bring some awareness to the side damaged by the stroke. She encourages Juana to talk through what she is doing with her mom to try and create an association between language and movement. They discuss how to use the wheelchair and simple things she can do to protect herself from injury.
“It’s a lot of education,” explains Alexa. “It’s actually all about the caregiver.”
I quickly learn that the real work happens at home. Patients are given instructions, guidance and exercises to take with them. Transportation is often a major barrier to care for low-income families. The cost of getting a patient to and from appointments may limit their ability to get consistent care.
“You can provide the best care in the world, but it doesn’t matter if the patient has no way to get to it.” - The Atlantic Monthly
And in cases like Cesarea’s, where the patient is virtually immobile, a large purpose of the physical therapy is to protect the caregiver. “Really, it’s about protecting Juana and teaching her how to care for herself while she cares for her mom,” Alexa tells me.
The pro bono clinic probably relies even more heavily on patient education than a typical for-profit clinic, and for good reason – the pay-off is high.
“A patient can come once a month with a condition that in a normal outpatient setting you would see them three times a week," says Katie, "and they are so motivated, so grateful for what they are getting, that they make dramatic gains, even with the less intensive care.”
The clinic is a place where patients come to find healing and hope. Simple yet profound, the work of physical therapy holds the power to strengthen and restore both the body and the mind.
Katie recalls a former patient of Alexa's – a woman with adhesive capsulitis, more commonly known as frozen shoulder. “When she first arrived, she couldn’t move her arm, but she gained a lot of range of motion with much less therapy than she would be getting in an outpatient setting because she did her home exercise program ten times a day. You tell them once to do their home exercise program, and they do it.”
“It is amazing to see how little of yourself you have to give to see a great improvement," continues Katie, "and how grateful people will be for what seems like so little. I don’t feel like I’m saving lives by taking someone through their exercise program or teaching them to walk, but you see a change in them overall. Their confidence in themselves and their realization that their future is attainable – that they might be able to get back to the way they were or that the future is going to be okay, they won’t have pain forever.”
“It doesn’t feel like we are giving so much for what they are getting and what we are getting back.”
That Human Connection
In the waiting room, Sister Dede brings the young girl an ice cream cone and is rewarded with a shy smile. “How is school?” she asks. “Good,” responds the girl, “I like it.”
Everyone matters here. The young, the old, the homeless, the poor, the immigrant, the uninsured. And everyone is cared for – both in the treatment room and in the waiting area.
“It all comes down to the importance of human dignity – that is what really draws people here, and why we stay,” says Katie.
Dignity is not a buzzword – it's a way of life, a standard of care, a culture that permeates the organization. And it shows itself in the little details.
“The sisters just work their magic in the waiting room,” explains Katie. “Where else do you go that you have concierges in the waiting room, talking to the patients, asking about their family, how they’re doing, getting them drinks, getting a little girl ice cream, taking kids outside to play? These are things that are all happening in the background, but make it such a special place.”
And with each hello, each inquiry into daily life, each effort to connect and care on a personal level, there is a statement of value.
"It’s that human connection," explains Katie. "The experience of looking someone in the eye who you would never see during the day and caring about that person is a profound one."
Yvette Francis started volunteering at the clinic about five years ago. She explains that healing goes beyond the physical. "The mental aspect plays a big part. We look at the whole musculo-skeleton system, but also you’ve got to treat the person as a whole. They are a human being. We just can’t say you have to look at this area, the arm or the leg. You have to consider the mindset, their cognition, all of that plays a part. You are treating the whole person, not just a part of the person."
Yvette starts every physical therapy session with one question: "What are your goals?"
"I may have the skills, knowledge and abilities to help a patient work towards achieving their goal," says Yvette, "but I first need to know what is that goal. Maybe it’s getting up out of a chair to go to the bathroom, maybe it’s being able to go down the steps to attend your grandchild’s recital. But I always focus on the patient’s world, the patient’s expectations and working with their goals first. That’s then how I develop a plan of care for treatment."
Yvette first learned about the clinic from her twin sister Yvonne, who saw a flyer at the hospital where she worked and signed up as one of the clinic's first volunteers.
Yvonne explains to me that treatment can look different for every patient, depending on the need. In some cases, patients are working towards recovery; in other cases, the patient benefits most from pain management or the tools to live with an ongoing condition.
"I remember three years ago, Sister Dede emailed me about a patient from Africa," she says. The woman was suffering from lymphedema (swelling in the arm resulting from the removal of lymph nodes during surgery for breast cancer). "She told me her son brought her to the United States because there was no treatment available in her home country. Lymphedema is a chronic condition, so it doesn't totally go away, but we can decrease the swelling. I showed her son how to wrap her arm and got her a compression sleeve. I also gave them some exercises to work on at home."
Therese Rodda is another volunteer who has been with the clinic since its early beginnings. With over 30 years of physical therapy experience, including running her own practice, Terri is a veteran in the field. And she sees the importance of a holistic approach as larger than just the patient.
"When these patients cannot access care in a meaningful way, they become a greater burden on the health system," explains Terri. "Right now, the health care system is very silo-ed. We need to be working together to identify populations at risk and doing something to be proactive rather than reactive."
That is just what the clinic is aiming to do. With a monthly diabetes clinic already underway, these physical therapists are taking a preventative approach to medicine.
"Once a month, we have an eye surgeon who comes and examines patients eyes for diabetic retinopathy, and the physical therapists screen for peripheral neuropathy and peripheral vascular disease," explains Terri. "We are trying to identify people at risk – we know diabetics are at risk for those three things, so we are trying to screen ahead of time to avoid greater complications. It’s also an opportunity to talk to them about blood sugar, diet, etc."
"For me, the most rewarding thing is to be able to help somebody transition from fear and pain to happiness and love."—Therese Rodda
Katie helped start the diabetes clinic. She explains to me how they start by cleaning the patient's foot, looking for any cracks, sores or debris that might be stuck in the foot. One of the side affects of diabetes can be loss of feeling in the leg and foot, meaning that a person might not even realize they have something in their foot making them vulnerable to infection.
"I’ll never forget one patient who once told me, in broken English, 'It’s like Jesus washing feet at the last supper,'" Katie recalls. "It kind of hit me, I never think of it like that. I just think of this as a procedure, a step in the process. But for the patient who has never had anyone take care of their feet before, especially someone they’ve never met, it can mean so much more."
"You can give someone a gift, with just a touch and a willingness to spend time and listen to them."
Something More Beautiful
When I ask Sister Dede about the clinic's greatest need, she answers without pause – volunteers.
"Alexa is here almost every other weekend," she explains. "We have a group of devoted volunteers, but we open the clinic every Saturday, so we need a lot of volunteers."
Everyone from the director to the scheduler to the physical therapists have chosen to donate their time. Volunteers like Yvette, Yvonne and Terri work full-time jobs during the week, but give up their Saturdays to serve patients at the clinic, in part because they believe in the work, but also because they enjoy being a part of the community.
"I enjoy coming here,” says Yvonne. “It's a breath of fresh air.”
Sister Dede also believes that volunteers enrich the environment for everyone. "Every time someone new comes, they bring in something more beautiful," she says.
She doesn't worry about the money. "That will work itself out," Sister Dede tells me. "But when people send us funds, we can use it for the patients." She remembers one young girl who had a tragic accident shortly after crossing the border and lost her legs. When the clinic received a generous donation, they were able to use the money to buy her a new wheelchair.
Interested in becoming a volunteer?
This is the kind of faith, generosity, humility, service, compassion and dedication that guides the organization – the kind of culture where people, not the bottom line, are most important – the kind of place that heals hearts and minds, all the while bringing people together.
“In our normal lives, doing what you do, you might never come across the people who walk through the door of this clinic. I think it’s really important for people to be exposed to that, in some way, even if it’s coming and helping the sisters move furniture to the basement," says Katie.