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Building Bridges with Virtual Hand to Shoulder Fellowship to Latin America

By Monica Eugenia Fuentes Ortiz, PT, OT

Virtual Hand to Shoulder Fellow, ‘22

My first encounter with hand therapy was a like going into a deep, dark cave with no map, no guide, and no light. I am a Mexican occupational therapist trained in Norway and I’m also a physical therapist trained in Mexico. Despite this extensive education neither prepared me for what was coming when I was suddenly assigned all hand patients at my new workplace 10 years ago. I was told that because I was an OT, I should be able treat hand patients.

I suddenly came across many diagnoses and procedures I was not familiar with, such as patients with CRPS, tendon flexor repairs, burn scars, sensory impairments, just to mention a few.

I was doing my best, but the results were not as good as I was seeing with the many other diagnoses I treat as a physical therapist. Recognizing that, was the turning point for me. I started digging into hand therapy, trying to expand and grow my knowledge. I was blown away by all the resources and information out there, but at least now I had something to guide me.

In these past 10 years I have traveled to get trained in hand therapy, and I bought books to learn more about the intricate beauty of the anatomy of the hand. The wrist was and still is a marvelous puzzle to me, but I love growing my knowledge to understand the complex biomechanics of the upper limb, wrist, and hand, and learning the many ways we as specialists can help our patients achieve a good outcome.

Slowly but surely, doctors in my city and other colleagues began to see me as the “hand therapist”. However, there were always new diagnoses, like complex hand injuries, that required a lot of research and reading because I just didn’t know how to manage them in the best way. I had little exposure to managing hand injuries despite my physical and occupational therapy education. For example, during my OT training in Norway, we had just ONE class for orthotic fabrication. So, in my efforts to develop my knowledge within the specialty of hand therapy, on I went with my reading, but I had no structure and no guide.

Eight years ago, I learned about the hand therapy certification. It was exciting to know that I could get certified to demonstrate my specialization, but also that there was a group of people worldwide who shared this passion for the hand that I could become part of. I even travelled to Baltimore for the ASHT Hand Therapy Review Course in 2014.

I was really hoping to sit for the 2015 exam, and then I realized ALL the information I had to learn in a few months. It was overwhelming. There was no way I could learn all that with a full-time job and two small kids. Most universities in Mexico just brush over the hand anatomy because ¨there is no time, and there was a huge gap of knowledge in topics like treatments, special tests, and surgical procedures. I bought the Purple Book and started taking small quizzes to train my performance in multiple choice exams. I loved the sections and topics that were so well organized. And then 8 years suddenly passed, and I began feeling that my aspiration to become a CHT could become an unattainable goal, unless I did something about it.

One day looking for online courses about hand therapy, and, somehow, I came across Virtual Hand to Shoulder Fellowship. Founder and Faculty Dr. Mirella Deisher offers a solid, structured 1 year long program with lectures in real time, private mentorship, opportunities to debate and share with colleagues all over the world who were in a similar learning process, AND that also prepares you for the CHT exam!

I had found the guide.

During my time in the fellowship, I can say with no doubt that I am a different therapist now than before. It is not just the knowledge I have now, it is the critical thinking process that comes whenever you have a patient in front of you and the treatment begins. Undoubtedly, knowledge opens your perspective, minimizes the risk of choosing less effective treatments, and increases the odds for a great result for a patient that trusts you, that believes you can help him.

There are 7181 Hand therapist worldwide. 6625 are in the United States, 452 in Canada, Australia and New Zealand. 104 in other countries. Based on the HTCC website, Latin America doesn’t have even one.

How can this possibly be? I believe the language barrier is the most important factor, since the test is in English and the topics are complex to read in a language that is not your own. We never learn the anatomy in Latin, so for us in Spanish speaking countries, the carpal capitate is called ¨the big bone¨ and the latissimus dorsi is the ¨broad dorsal¨. We must unlearn a lot in order to learn more!

I believe it is possible to change this. We have to be able to spread the word, to make this amazing knowledge available to other therapists. Millions of patients out there deserve the chance of receiving the best care regardless of their socioeconomic status. We owe them.

For this reason when Mirella invited me to be a part of Virtual Hand to Shoulder Fellowship to start a Latin American cohort, I felt incredibly honored to help build a very much needed bridge, a bridge that can let many therapists in Spanish speaking countries have access to in-depth knowledge, specialized skills, techniques and protocols that would otherwise be very difficult to attain.

I truly hope The Latin America VHSF cohort becomes a source many turn to, and that it can ignite the spark we need to train great hand therapists in this beautiful part of the world.



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