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DOs Teach Osteopathic Manipulative Medicine in Madagascar

February 27, 2017

By Andrew P. Peck for AODME.org.

Sandra Koehn, DO provided CME on OMT to Malagasy Physicians as part of an annual elective program with Western Michigan University’s Homer Stryker MD School of Medicine
Sandra Koehn, DO provided CME on OMT to Malagasy Physicians as part of an annual elective program with Western Michigan University’s Homer Stryker MD School of Medicine
In the island nation of Madagascar where access to modern medicine is scarce, the demand for non-pharmaceutical treatment is at its peak. During October 2016, dozens of Malagasy physicians were taught the healing techniques of Osteopathic Manipulative Medicine from resident DOs participating in an international health elective through Western Michigan University’s Homer Stryker MD School of Medicine.

For the past 16 years the WMU Homer Stryker MD School of Medicine has offered an international health elective in Madagascar led by faculty member Richard Roach, MD. The program works closely with a Malagasy physicians group called Samp An’Asa Loterana Momba Ny Fahasalamana or SALFA (translation: Malagasy Lutheran Church Health Department). The SALFA group contains 150 Malagasy doctors from 25 hospitals and clinics throughout the island. The rotation involves seeing hospitalized patients as well as working in an outpatient facility. During the month-long elective, students and residents from WMU Homer Stryker MD School of Medicine and participating schools including Michigan State University College of Osteopathic Medicine are paired with English-speaking Madagascan physicians.

While the purpose of the program is primarily to educate American healthcare providers and students on the treatment of tropical diseases, the Malagasy doctors benefit from the knowledge-sharing aspect of the elective. The rotation is a valuable opportunity for American residents to see a variety of tropical diseases, including malaria, Schistosomiasis as well as a myriad of intestinal parasites. In turn, Malagasy physicians receive training on a number of topics – including Osteopathic Manipulative Medicine.

“They (Malagasy) want to learn how to treat diabetes, hypertension and acute stroke,” Dr. Roach said. “The most common cause of death in Madagascan adults is a stroke – due to high blood pressure, which has gone untreated. In the past most people thought high blood pressure was due only to a certain diet but it’s often hereditary.”

Sandra Koehn, DO, PGY 2 IM, who is completing an Osteopathic-Focused residency was tapped by Dr. Roach to provide training on OMT with the help of another osteopathic resident, Prashant Patel, who participated in the demonstration.

“I have always been interested in traveling and practicing medicine abroad,” Dr. Koehn said. “When I talked about this opportunity with Dr. Roach, it sounded like a great chance to use my skills and talents for the greater good. It is something truly special to meet people with completely different life experiences and connect through health care.”

Dr. Roach said the Malagasy doctors had received OMT training on a previous trip by the elective program three years ago. The CME session facilitated by Andrea Landon, DO was so well-received that the SALFA group requested more of the same.

“You can see the beauty of this,” Dr. Roach said. “First of all they have limited resources. They wanted a new approach to managing some of these problems. When you have limited resources you need an alternative that is actually effective and inexpensive.”

Sitting in an upstairs room at a facility owned by the local hospital in the capital city of Antananarivo, Dr. Koehn heard chickens and roosters exclaiming from the courtyard outside. There were several windows but no screens so flying objects made their way into the classroom at will. All the while, Dr. Koehn felt apprehensive while watching her American colleagues providing more traditional medical lectures.

“I sometimes wondered how they were going to respond to this very different type of lecture,” she said. “I was nervous. My husband (Zachary Koehn, DO) was on the trip with me. And I would ask him how this would go. He was really encouraging, telling me it was going to go great.”

Dr. Koehn said that while the terminology she conveyed during her OMM lecture was met with blank looks from participants, things began to click once the hands-on demonstrations began.

“We taught simple and effective techniques they could use on their own patients,” she said. “I tried to find indirect myofascial and soft tissue techniques. It’s a lot like leading the body take to a position where it is at ease. You sort of take the tissues to a point of relaxation and let them melt under your fingers. You’re using breathing techniques as well so people can feel that difference before and after. They surprisingly had a knack for it.”

In addition to her husband and Dr. Patel, Dr. Koehn was assisted in the demonstration by other DOs in attendance including Emily Cordes, DO, Emily Gray-Goerl, DO, and Amber Fausneaucht, OMS-IV from MSUCOM.

Dr. Roach said he received raving feedback from the Malagasy physicians.

“They were ecstatic about it,” he said. “They really enjoyed it.”

After living out one of her lifelong ambitions by helping pass knowledge on to physicians in the developing island nation, Dr. Koehn talked about what she’d learned during her journey.

“I realize now how fortunate I am to live in and practice in (the United States),” she said. “We are so fortunate and have so much offered to us with social services, community support and government support. People who can’t afford healthcare still get most of what they need compared to people of the world who don’t have anything. Understanding that gives you a whole new perspective.”