The People Who Never Heard of McKenzie
“Estaba un placer. Gracia para veniendo. Buenas dias.”
In my broken Spanish – “It was a pleasure. Thanks for coming. Have a good day.”
As the attendees gathered their notes and filed out, a twenty-something Guatemalteca female therapist named Raquel approached the podium at the front of the room. She was dressed professionally, wearing the type of glasses that make you think of someone who studies a lot. She asked thoughtful, curious questions throughout the presentation, but now she asked the one question I was hoping for, the solitary purpose of months of preparation, study and support from a half-dozen clinicians connected to The McKenzie Institute USA. She delivered the payoff with hesitation, like she knew she was asking for more than she expected to receive.
“Donde puedo aprender mas?”
“Where can I learn more?”
Why Guatemala Needs MDT
Guatemala is the same distance from my hometown as California, but it might as well be light-years apart. When America created its constitution in 1787, Guatemala, a nation the size of Ohio, was still ruled by Spanish conquistadors. Since the US declared independence, Guatemala has been separately ruled by Spain, Mexico, the short-lived Republic of Central America and autonomously. In that timeframe, it has had seven different constitutions and operated under socialist, authoritarian and democratic rule. Although The McKenzie Institute is one of the most well-established brands in therapy worldwide, here it might as well be a foreign language.
Typically, if you ask a room full of therapists what their opinion is of the McKenzie Method, you know what responses to expect. Some enthusiastically raise the banner or demonstrate respectful admiration. Others roll eyes or roll up their sleeves preparing for a therapeutic approach slugfest. But in Guatemala the response is fundamentally different – blank stares. We discovered this in late 2016. Nearing the end of a four-month stint in the country, I wanted to make a bigger impact than just seeing the patients who came in to the clinic. I wanted to find the therapists. I wanted to let them know there is a logical, intuitive and, most importantly, empowering system of mechanical care available to them.
I knew McKenzie could be revolutionary in a developing nation where the standard care for mechanical pain looks a lot like it did in America in the 1960’s. Everyone receives passive modalities: a hot pack, massage or PROM, e-stim if your clinic can afford a machine and definitely ultrasound for all the Bell’s Palsy patients. Through incredibly fortuitous circumstances, we made contacts with leaders in the local therapy community who expressed a desire to learn more about this completely unknown way of practice. Seizing the open door, we offered the first-ever Guatemalan MDT introduction on three different days, in three different regions (Zacapa, Antigua and Guatemala City) to 87 practicing rehabilitation specialists and two physiatrists. It’s almost too fantastic for a US-based therapist to believe – Robin McKenzie and his infamous Mr. Smith to be unknown. As the responses lined up, it was clear. Less than 5% had heard of the name McKenzie. Even then, the most knowledgeable of those could only associate him with a specific extension exercise, not a system.
A lack of familiarity was not the only unexpected difficulty. For example, as we shared information about the objective reliability and validity of the McKenzie Method relative to palpation and other assessment measures, we discovered the impressive figures on the 0-1 scale were undercut by the fact that research evaluation is not a covered subject in therapy curricula, rendering the argument meaningless. “Centralization” was another new concept entirely foreign to their practice which, when explained, the audiences quickly grasped its significance. The difficulty describing “Peripheralization” was more substantial. As far as we could tell, no word yet existed to define that phenomena. One morning in rural Zacapa, I was humbled as I began outlining the stoplight rule, only to realize most students in the class had never even encountered a stoplight in their daily lives.
A New Hunger
Despite the cultural obstacles, the strength and rigor of Mechanical Diagnosis and Therapy revealed a level of care powerful enough to capture those in attendance. In fact, on the last day, Claudia and Juan Cicneros, our hosts for the day and owners of one of the largest medical companies in Central America, had to turn professionals away at the door. Participants heard a brief overview of the system, saw a demonstration and were able to practice active problem solving and classification in small groups. The response was like someone who has only ever eaten off a restaurant appetizer menu, now seeing the whole menu unfolded before them for the first time. They embraced it and were hungry for more.
Guatemalans have a reason to be hungry. Compared to its tourist-favorite and border neighbor Belize, Guatemala is four times larger and has 43 times the population. One perfect example of the economic and political struggles holding the country back due to debt and embezzlement, nearly all of the country has no mail service. Thinking this was an exception, we experienced this first hand when we attempted to send mail home, realizing that it literally was an impossibility to send mail, regardless of money. We traveled a few miles across the border and the same package went from Belize to Chicago for 60 cents. Each tidal wave of positive momentum over the last 300 years had been pulled under by greed, government corruption, civil war and the like.
Hope for the Future
Change is coming through people like Claudia and Juan, who are passionately leveraging their position in the medical community to offer education to the locals (or “ay-do-cation” as Juan says it.). Schooled in America in their youth, they believe passionately in the innate importance of training as the vehicle to drive change for their broken country. For this reason, and at no profit to themselves, they’ve offered any and all training they could get their hands on at their state-of-the-art facility in the capitol at no cost. In recent years, they’ve hosted a series by a scoliosis specialist from Europe and, in a remarkable feat, last year coordinated the first Mulligan series, culminated by a certification examination in December which was completed by over 20 people paying over $500 per level. What they really want now, they say, is McKenzie.
“The people are hungry, but they don’t have access to what they need,” Juan remarks. They say Guatemala has been poor so long, that it has transformed the way people think. They hold onto to whatever knowledge or training they can put their hands on, rather than share and dispense for the common good. It sounds a lot like Depression-era hoarding, everyone hiding copper pennies under their mattresses.
Locals tell a popular legend. There were two fishing boats, one full of American lobsters and the other full of Guatemalan lobsters. In the American boat, the fishermen had to place a cover over the lobster cage because the lobsters kept climbing up each other and escaping out the top. As the tale goes, the Guatemalan cage didn’t need a cover, because any time a lobster would try to climb out, the other captives would pull them back down.
Juan reflects on this story with a resolved surrender, but you can see a determination to change the way things have been. For decades, this has been the way of things, but there’s hope for change. For the first time, a class of people have the financial ability to pay a fair wage for advanced training like MDT. More importantly, talented and motivated advocates like Juan and Claudia, working together with others like their PT friend Marta, who founded the first-ever PT association in Guatemala, are committed to bringing whatever will best help PT in their country, and eventually help every person. Good people looking to raise the level for all in Guatemala, not just keep everyone else down.
As of this writing, representatives of the Guatemala constituency are in talks with The McKenzie Institute International to coordinate presenting the full MDT Series and Certification, for which 30+ local therapists and delegates from bordering Honduras have expressed interest.
For more pictures, please see the pdf below.