CR Part 2: Working at Manos Abiertas

If you’ve missed any previous posts, check out the food I ate while in CR and Part 1 of my journey. 

The first Wednesday of the trip started our time in different facilities around Alajuela. About 16 of us were staying at Manos Abiertas (me included) to work in the hospital portion with the children; the other classmates were split in to three groups: one working at a skilled nursing facility, one group traveling to Tres Rio at the Manos Abiertas up there, and one group splitting time between an adult day care center, a center for young mothers abandoned by families (ages 13 and up), and two other facilities in the area.

I will obviously only be talking about the Manos Abiertas Alajuela group, since that’s where I was placed. If you want to check out what happened at the other groups – head over to the MU blog that I kept throughout the trip!

Team Pam: the Manos group!

You got a brief history about Manos in the previous post, so I won’t bore you with that. But instead of working with the residents in the adult houses, we were mainly in the hospital portion of Manos, with the children. Because this was not the first year that Marymount has been at Manos, our faculty had a set plan of what needed to be done during our time there. I really wish I could have taken pictures of some of our work, but unfortunately we were not able to take pictures of the residents. Here is what the PT gym looked like:



And the view from the window:



The facility was very nice and we had plentiful supplies to work with the children. However we had difficulty finding supplies for our main tasks: positioning. Positioning, in PT terminology, consists of basically what it sounds like: placing the patients in optimal positions while they are not moving. Many of the children were fully dependent or had minimal postural control. Additionally, because many have neurological disorders, spasticity and increased tone was very common. This basically means that their muscles tighten up to an extent that they remain positioned in tight positions and it is very hard to break the tone. In order to prevent skin breakdown and other negative effects of high tone and poor positioning, our goal was to go to every patient and use pillows, bolsters, foam, towels, sheets and everything we could get our hands on to educate the caregivers on how to best position the patients to reduce the risk of these negative effects. The PT at Manos then came around and took pictures of how they were positioned in bed (on their sides and on their backs), and the pictures were going to be put up bedside so that the caregivers could see the optimal position every time they put them in the beds. This task took up mostly all of Thursday and Friday.


Saturday morning, Monday and Tuesday focused mainly on positioning in the wheelchairs. Similar with the positioning in bed, we observed each individual’s natural posturing in the wheelchairs on Saturday and began work Monday and Tuesday on adjusting everything. This is where we had to get very creative. We had minimal supplies readily available to us to help promote the positioning that we wanted. We ended up, somehow, with a large piece of foam. We’re talking 6 inches thick and about 8×5 feet. We used a butcher knife to cut it and used paper to measure wheelchair seats and arm rests. We learned we can be mighty resourceful – that’s for sure! Unfortunately, I wasn’t able to attend work on the second Monday of the trip (when most of the wheelchair positioning got done), because I was sick. Because the children are so vulnerable to getting sick, we were not allowed in the hospital if we showed any signs of an illness. A few of us caught a little bug while down there which put a big downer on the trip, but we all knew it was for all of ours safety to stay behind.


We had a really good system down of working with the children while their chairs would get worked on. So while most of the men used the tools to take apart chairs and put them back together and contrast a new sitting support system, a few others would be doing exercises on the low mats with the children: working to reduce tone, working to increase postural stability, working to improve neck control. It was extremely rewarding working with these children and recognizing how much of an impact our work had on them in such a short amount of time. One thing that a lot of us struggled with is the fact that we know that these children would probably be much higher functioning if they were in the States. Because of where Costa Rican health care is in relation to where we are in the States, the children aren’t getting the sensory stimulation and PT that they need to thrive. In the short amount of time that we were with these children, I had a patient (whom I fell head over heels in love with and cried on multiple occasions while working with him) who improved his head control and showed improved postural stability after just 2-3 sessions of simple exercises. The Sisters and caregivers at Manos are incredible people. They are inspiring, compassionate, loving women and they care more about these residents and children than you could ever imagine. They provide them with the best care that they are able to give and they are so open to learning from us and from others who come in to help which is amazing. It just shook me when I realized the life that most of the children could have if they could receive this type of care and physical therapy every day.

Back tracking a bit– I skipped over our day at Manos on Wednesday because we were not with the children in the hospital, we were with the residents of the adult houses for day 3, the final day, of the camp that they we were running with them (the field trips included). It was one of my favorite days of the trip. Again, we couldn’t take any pictures which is very unfortunate to you all as I try my best to explain what we did all day.

The day started with a special mass. For this mass, we helped get each of the residents dressed in their “Sunday’s best”, and helped the Sisters and caregivers with putting make up and jewelry on the residents. This was amazing for us to see. It showed us that a little bit of make up can make anyone feel beautiful and that beauty is an international language. It was incredible to see how excited the residents got over a few swipes of eye shadow and lipstick and a new necklace. It also gave us a million idea in our heads of more things that we can donate to Manos when we get back to the states.

At the mass, a classmate joined the guitarist and played along solely by listening and watching him play. No sheet music needed.


Following the mass, we headed over to the stage/play area/field. Its a basketball court with a stage at the end, covered for shade, next to a small soccer field. That is where we spent the majority of the rest of our day. We had a potato sack race with the residents that were able to participate, we had a tug of war contest, and most importantly, we had a water balloon fight. This water balloon fight turned in to a water bucket fight, which turned in to “Let’s just bring the hose out and spray EVERYONE”. It was so much fun. The residents were all cracking up at watching the Sisters splash everyone, the residents themselves were getting soaked, the Sisters were chasing us around the field trying to get us with the buckets. I even got schooled in soccer by one of the Sisters. (She’s like, 30, not 80, and she was good.) Following lunch, the day ended with a huge fiesta! The residents got all dressed up again and we brought them back to the covered area for a big party! A DJ came and was playing a lot of fun music to dance to and we really got a chance to see each of the resident’s personalities come out. My classmates and I were just switching off dancing with everyone, getting dressed up in props that were brought out (i.e. big clown bow ties and hats) and enjoying the evening. We all agreed that although we really didn’t do any “PT”, just our being there and being with the residents, dancing with them, showing them attention really brought out their personalities and we saw a side of them that we hadn’t seen the previous days. My wish for them would be that that could happen on a weekly basis.

Overall, my time at Manos was incredible. It was heart warming, it was eye opening, it was a learning experience, it was a blessing. I wouldn’t change my time with those kids and adults for anything and I am so, incredibly blessed that I got to experience that with some of my best friends and colleagues.

Our final day at Manos

Our final day, the Sisters threw us a breakfast party with eggs, bread, and coffee. It was their way to give thanks to us for all of the work that we did. It was so sweet and generous. I hope that in my professional career that  I can show half of the compassion and love for my patients as the Sisters do for the residents of Manos Abiertas. 



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