A US Navy Occupational Therapist: From Pediatrics to Hand Therapy

Written by:

Maya N. Bell, M.Ed., OTD, OTR/L

Lieutenant Commander, US Navy

Virtual Hand to Shoulder Fellow ‘22

I am a native of Oakland, CA. I attended Howard University in Washington, DC where I received my Bachelors of Science degree in Occupational Therapy in 2003. I later attended the George Washington University, also in Washington, DC where I received my Master degree in Education and Human Development with an emphasis in Special Education in 2006. In 2010, I graduated with honors from Temple University in Philadelphia, Pennsylvania with my Doctorate of Occupational Therapy degree with an emphasis in Early Intervention and School-Based Practice.

Remembering back to my undergraduate college days, I loved the structure and organization of what the ROTC program provided me. At that time, however, I was unable to finish the program and join the military; I felt like I left something unresolved. A few years later, I was ready, and resolved to join the military. Oh, what a journey it has been!

There are pros and cons to every job and the military is no different. In general, the military has some amazing and unique opportunities for OTs. The Navy OT community is small, but its impact far exceeds its numbers. Being multi-dimensional is OT’s biggest strength.

I was commissioned in the United States Navy July 2014 as a Lieutenant. My first duty station was at US Naval Medical Center San Diego from 2014-2016 as Occupational Therapist and Division Officer of the Occupational Therapy, Physical Therapy, and Chiropractic Medicine Department. I led active duty and civilian providers across four clinics. I primarily served as the early intervention, rehabilitation, and feeding specialist in the Neonatal Intensive Care Unit (NICU). I was the only active-duty provider Navy-wide privileged to provide rehabilitation services in the NICU.

In May 2016, I reported overseas to U.S. Naval Hospital Okinawa, Japan where I served as Department Head, Educational and Developmental Intervention Services (EDIS) and lead Occupational Therapist. In July of 2019, I continued my tour overseas and reported to U.S. Navy Medicine Readiness and Training Command Yokosuka, Japan at the branch clinic U.S. Navy Medicine Readiness and Training Unit Iwakuni, Japan where I was promoted to Lieutenant Commander. There I served as the Department Head, Educational and Developmental Intervention Services (EDIS) and lead Occupational Therapist. I led over 40 active duty and civilian staff across six locations throughout Mainland Japan.

Continuing my overseas tours, in the Asia-Pacific, July 2022 I reported to U.S. Navy Medicine Readiness and Training Command, Guam. I currently serve as Department Head for the Physical and Occupational Therapy Department.

Unlike in the civilian sector, where providers can get “stuck” into one practice area and find it extremely difficult to change settings, Navy Occupational Therapists have a wide scope of practice settings. We provide care to clients who have sustained burns or trauma, individuals who suffered from neurological (Cardiovascular Accident or TBI), Spinal Cord Injuries, Orthopedic, Pediatric, or Combat and Operational Stress.

Navy OT’s can also expand their impact, such as through deployment in support of humanitarian missions aboard the hospital ships, USNS Mercy and the USNS Comfort. During these partnerships, the OT provides consultation, direct patient care, and education to the host nation’s staff and their families.

Navy OT’s provide Combat Operational Stress Control in order to better serve the behavior and mental health need of the warfighters. Occupational Therapist’ unique skills in psychosocial, ergonomics, and operational and combat stress management can create opportunities for future Navy OT’s in support of the fleet to prevent the devastating effects of combat, operational and deployment stress, burn-out, compassion fatigue, and personal, inter-personal and sexual health and intimacy problems. These skills are well-suited for military-related medicine and the availability of these services has helped to eliminate stigma Service members may have in seeking assistance in the areas of behavioral or mental health services.

OT has been a vital component in Concussion Restorative Care, as they assist in the recovery of the physical and emotional injuries related to a concussion, which was one of the signature wounds during times of global conflict or war.

Occupational therapy treatment is instrumental in returning Service members to their respective units at the highest level of readiness and with the ability to withstand the rigors of deployment. Working with our nation’s heroes, assisting them in their recovery, enables them to serve and protect our country, making the role of OTs both vital and rewarding.

It has now been 20 years of practicing in the field of occupational therapy and 9 of those years, serving as a Navy Occupational therapist. Even with the wide variety of settings that Navy OTs work in, I have been fortunate to be able to continue practicing in the pediatric setting, which is where I have practiced my entire career. It was what I knew and what I knew well. The nature of the job, however, is that every 3 years we move around to either different states or even different countries. Even though I have been fortunate to remain working in the same setting at each location, most do not.

The primary positions for Navy OTs are in hand therapy clinics. My time came to move to a location where I would be practicing in this setting, and I knew absolutely nothing about hand therapy. I remember in undergrad we had a few brief lectures and made a splint or 2 but that was it; that was the extent of my exposure and knowledge in hand therapy. Not to mention, that by now, that exposure to hand therapy was 25 years ago.

The hardest part about this transition to a hand therapy setting was that there would be no training, and I would be the only military OT on the island of Guam for Navy, Army, Marines, Air Force, Coast Guard, and National Guard, serving over 21,7000 Service members and their families, so there was no one for me to turn to for guidance. The site is supposed to also have an OT assistant at this location, but that position had not been filled in over 2 years. I would be the sole provider.

Thus, I took it upon myself to research some training programs that I could at least take online. I was living in Japan and about to move to Guam, so there were no local or in-person trainings that I would be able to take. Upon doing my research, I came across the Virtual Hand to Shoulder Fellowship. I reached out to my Command to see if they would fund the program for me to attend. Ultimately, it was denied because “it would provide no benefit to them” since I was there as a pediatric therapist and the hand therapy training would only be of benefit to the upcoming Command. I had to make the decision of whether to pay out of pocket or not. I have always been so confident going from Command to Command because I knew my job and I knew it well. This time around that was not the case. I didn’t know my job, I would be the only hand therapist, and everyone would be sending their patients to me with the expectation that I am the expert. Additionally, I would be the person responsible for both the Physical Therapy as well as the Occupational Therapy department and I didn’t even know my own job. I don’t like the unknown and I was faced with many unknowns being thrust into the world of hand therapy.

I decided to go for it. So, while I was still practicing in the pediatric setting, I started the Virtual Hand Therapy Fellowship. I had about 7 months before I would move and start practicing in the hand therapy clinic. I figured this would give me an introduction and I would be able to have at least the basic knowledge going into this completely novel position.

I appreciated the first trimester. It was a review of the anatomy of the upper extremity. I hadn’t taken anatomy, physiology, and kinesiology since undergrad. I barely remembered any of this but a few things jogged my memory. As we got into the second trimester and started studying more about the diagnoses, things started getting more complex. It was hard for me to fully grasp the concepts because I wasn’t working in that setting yet. I stayed in communication with Mirella, seeking guidance, however, I was not yet able to apply the learning, which makes it much harder.

Fast forward 7 months, and I finally arrived at my new Command in Guam. The person I was replacing had already left so there was no turnover, no one to give me a brief about how things were run in the department, about caseload, providers, nothing. Again, I was left to figure things out, so I first reached out to the Referral Management office because I wanted to get a list of the type of injuries that patients in the OT department were seen for. Reading over that list was so overwhelming. The little bit of knowledge that I thought I had, went straight out the window. I felt like I would never learn all of the knowledge in order to be a decent provider. There were so many different types of diagnoses and post-ops.

A few months after my arrival, we entered the third trimester of the fellowship. This was more in-depth, covering more complex diagnoses. Far beyond my capabilities as a provider new to hand therapy. The information was way over my head. During the weekly case study discussions, and even during class, the other fellows were better able to ask and respond to questions. Many of them work in hand therapy settings and they were more accustomed to seeing these types of conditions. While I felt like my situation was completely different than the other fellows, having no experience in hand therapy, I still attended every class and took notes because I knew once I started treating a growing caseload, I would be able to look back on them and they would come in handy.

Now, that Fellowship has come to an end. I have spent the last year learning about the upper extremity but only the last 6 months actually practicing in that setting. I am truly grateful to Mirella and The Virtual Hand Therapy Fellowship program. I have become much more comfortable and confident in providng upper extremity care to the patients that come my way. I still have a long way to go but because of the program I am headed in the right direction with all the right resources and support.