One-stop shop for physical rehab

In two years, the Rehabilitation Institute of the Caribbean has not only doubled its square footage but has also almost quadrupled its patient population. However, the institute’s founder, Dr Paula Dawson, has her sights set on doing even greater things over the next three years.

Dr Dawson, who is one of three US Board-certified physiatrists in the Caribbean, opened the doors to the institute in 2012, and, since then, has been on a mission to provide complete medical care for functional performance under one roof.

“We are seeing anywhere between 30 and 40 patients a day… about 200 to 300 sessions per week,” Dr Dawson told the Jamaica Observer in a recent interview.

However, with a shortage of rehab doctors in the region, she is aiming even higher.

“I used to see patients and I needed that patient to do occupational therapy or physiatry or speech and language therapy and I couldn’t really find the components together,” explained Dr Dawson. “So, having all of this together allows me to better provide that care for each patient.”

“We want to bring the model of multidisciplinary care, where you have the patients being seen for a particular problem in one place,” explained the physiatrist, who also lectures full-time in physical medicine and rehabilitation, and sports medicine at the University of the West Indies (UWI), Mona.

“For example, a stroke patient might have weakness, so he gets physiotherapy. A stroke patient may (also) have problems getting dressed, so they have occupational therapy; they may not be able to swallow, so they may need a speech and language therapist; and they may have cognitive issues, so they may need a neuropsychologist,” she explained.

“On top of that, they may need also aquatic therapy, which we have; we have a heated pool with underwater treadmill and underwater bike. So patients can get everything here now,” she continued.

The institute, which is an outpatient centre for physical medicine and rehabilitation, provides medical care for adults and children, enabling them to recover physically and regain their skills after injury or illness. Its treatment approach essentially includes medication, physical modalities, physical training with therapeutic exercise, movement and activities modification, adaptive equipment, orthotics (braces), prostheses (artificial limbs), as well as patient education, and neuropsychology treatment.

But, according to Dr Dawson, the institute is now operating at 10 per cent of the capacity that she envisions.

“What I want to have it become, and I don’t like the word medical tourism, but I do want Rehab Institute of the Caribbean to be a rehab centre where people from the region can come for specialist rehab treatment,” insisted Dr Dawson.

The institute’s team now includes a physiatrist, physiotherapist, occupational therapist, neuropsychologist or clinical psychologist, speech and language therapist, massage therapist, and nutritionist.

Dr Dawson, who also has training in interventional spine, musculoskeletal and sports medicine rehabilitation, wants the institute, which is located in the Liguanea Post Mall in Kingston, to have multiple units.

“In three years, we want to have a multi-unit institute where each specific rehab has its own space to allow for maximum care, without any limitations,” she declared. “Our goal is to have an institute… that provides the individual specialist care in the different areas of rehab [whether it is] in physical therapy, occupational therapy, speech therapy, neuropsychology, neurological disease, paediatric, cardiac rehab, prosthetics… and bracing, and other basic medical equipment where patients can come in and get affordable, good-quality products.”

This, she said, will include a paediatric section with a rock-climbing wall for children to strengthen their arms, a regular therapy section, a sports section, a neurological section for stroke patients, and cardiac rehab.

She admitted to the Sunday Observer that physiatry is relatively new, and though there are good doctors in Jamaica and that on the island currently there is some amount of opportunity for rehabilitation medicine as it relates to having a co-ordinated approach to patient care, this does not exist in one location.

“Another way we explain physiatry is, take for example, an orthopaedic surgeon or a cardiologist or a brain surgeon who may save somebody’s life. They may have been in a motor vehicle accident and the limb is mangled, they may have to cut it off or they’ll bleed to death; or they may have had a brain injury or heart attack or something, so you cut the leg off, the surgery is done; the quality of life — that’s where we come in,” Dr Dawson explained.

“We’ll do the bracing, dealing with all the complications, the bedsores… Physiatrists would say that while the surgeons and internists might save somebody’s life, we add quality to those years,” Dr Dawson argued.

“It’s bringing the body back to maximum performance without surgery, by using therapy, exercise and medication,” she continued.

She is hopeful that there is a bright future for physiatry in Jamaica, however.

“I am hoping that one or two students in every class at UWI will go into physiatry. So far, since I have been lecturing, I have at least two in each class. I hope they will go and do the residency and come back to Jamaica, and the rest of the Caribbean, so we can have more physiatrists providing more rehabilitation medicine,” she said.

Though the institute has grown, Dr Dawson said that not many people are aware of what physiatry is, and the role it plays in rehabilitation, pain management, arthritis, sports medicine, and stroke, but that is gradually changing. And, she is committed to raising the level of awareness about this branch of medicine.

“Once patients come and understand what it is, they are like, ‘why didn’t I hear about it before?’,” shared Dr Dawson.

However, although more people are learning about it, compliance remains a major problem.

“Compliance is an issue, but our therapists are very encouraging; we have to motivate the patient. A lot of patients who have had severe pain are motivated by the pain, there are patients who forget the pain until it comes back again,” said Dr Dawson. She is, however, countering this by providing patients with handouts to remind them of simple exercises to help them stay on the right path.

She shared that, based on the rehabilitation services offered, not everyone will walk or regain full cognitive ability or even their ability to swallow, but physiatry takes people back to their maximum potential within their limitation.

So how does the physiatrist feel after working with a patient who has been able to achieve their full potential?

“I feel wicked! I feel happy for the patient,” said an elated Dr Dawson. “I mean, it is just amazing.”