Project Africa: Teach One, Treat Many

Richard Jackson, PT,DSc(hon),OCS has practiced physical therapy for 49 years. He graduated in 1971 from Ithaca College/Albert Einstein College of Medicine. He received an honorary Doctor of Science degree from Shenandoah University in 2000. He was honored with the Practice Award in 2010 from the American Physical Therapy Association, (APTA) “for innovation and outstanding contributions to the practice of physical therapy.”

In 2018 Richard received the Societal Impact award from the APTA  which "specifically recognizes individuals who exemplify...a distinguished commitment toward philanthropic initiatives" for his educational development work in Africa. 

Mr. Jackson is highly regarded as a clinician, educator, and researcher. He has taught nationally and internationally in the field of lower extremity bio-mechanics and is well published in his field.

Richard is President and Executive Director of Clinical Services for The Jackson Clinics, LP, with 21 locations in Northern Virginia and is President of the Jackson Clinics Foundation, Inc.   

The challenge in Rehabilitation in Africa is two-fold. First, some countries do not have formal educational programs. People with spinal cord injuries are sent home to die, children with disabilities are left in bed, and people who experience physical trauma and injuries are left untreated. The second challenge is that those countries that do have educational programs are 50 years behind in the content that they teach. All have been left behind.

Our Foundation develops advanced educational programs in Rehabilitation and sends teachers and mentors to train students and teachers to raise the level of practice in under-served countries. We are actively teaching at Kenya Medical Training College and AMREF International University, both in Nairobi. We are also working in Mozambique. Funding would allow continuation of these activities.

We have published several papers that objectively demonstrate the effectiveness of our programs in raising the level of care to patient populations.

According to United Nation statistics, there are currently over 600 million persons with disabilities throughout the world of whom 80 million live in Africa. One out of every fifty people living in Kenya has a disability.  A recent study of rehabilitation in Africa concluded that "rehabilitation services are insufficient and marred with inadequate political commitments. Expertise for rehabilitation is scarce and poorly coordinated." The World Health Organization reports that people with disabilities "were more than twice as likely to report inadequate health care provider skills and four times more likely to report being treated badly." In short, rehabilitation professionals are scarce and poorly trained which means people with disabilities lack access to adequate skilled care.

The fundamental causes of the problems are a shortage of rehabilitation professionals, a shortage of educational programs, and outdated content within those programs leading to inadequate education of existing professionals. Our activities are increasing educational capacity and quality of care for people with disabilities in several African countries. We do this by starting modern educational programs at Colleges and Universities and by upgrading the education of existing practitioners. A key factor in this process is a strong program of clinical mentoring over patients.

Our project provides access in developing countries to current concepts in physical therapy theory and practice. We meet a desperate need in sub-Sahara Africa where the disabled of these countries are under-served, poorly served, or not served at all. Our process begins with an invitation from an institution in a host country.  Next we meet with their administration in assessing their specific educational needs and wants. We then develop under graduate to post graduate curricula to meet those needs. We recruit and send University professors and advanced clinicians from the United States to teach the curriculum and mentor students. Our Foundation coordinates the project and provides the airfare. The teachers volunteer their time, usually in two week blocks, and the host institution provides housing. That way everyone has a stake in the program. In certain instances distance learning is possible but hands on training in lab and over patients is critical in physical therapy. Sustainability is essential. Our volunteer teachers identify outstanding students who are invited in subsequent years to be teaching assistants. They eventually begin teaching parts of the material. We train them in teaching methodology and mentorship methodology so that they can eventually take over the teaching duties.

Our projects are intended to improve the lives of physically disabled people in sub-Sahara Africa. We address specifically individuals with neuro-musculo-skeletal impairments. Part of that process is to educate clinicians in the skills that they need to be effective in treating the disabilities that they encounter. So, we are working with two communities whose lives and outcomes are inextricably linked. 

I began to appreciate the extent of the needs when I was a Peace Corps volunteer in Kenya some 45 years ago. The conditions leading to disability are far more profound than in the developed world. My travels throughout a number of African countries, including extensive visits with clinicians, hospitals and clinics have elucidated the extent of the problems.

We have found that there is often a lack of understanding by the medical community that there are effective treatments available for common conditions. Women's Health is one example. Women throughout Africa suffer from terrible but treatable pelvic floor dysfunction. Some are cast out of their homes and villages. We are one year into a training program for physiotherapists to teach them how to treat these conditions. It simply takes access to modern education for African clinicians to treat people effectively.

Is anyone left behind more often than the child who can't walk, the person with a brain injury, or the person who sustains a spinal cord injury and is left in bed because no one knows how to treat them? Children, adults, the elderly are all left behind when their physical system does not work like everyone else. Physical Therapists are the only practitioners trained to rehabilitate these individuals. Our Foundation provides access to the education clinicians need to effectively treat all physical impairments. The clinicians we encounter desperately want to help in their communities. We teach them how.

My wife and I started The Jackson Clinics in 2003, an out patient physical therapy practice. When our business stabilized in 2010 we decided to start an international service opportunity for our staff. At that time one of our directors, Ethiopian born, decided to return home to do what he could to improve physiotherapy education. That led us to decide that Ethiopia would be the first country in which we would work. Once we arrived at Addis Ababa University the need was obvious. A country of 85 million people and only 200 physiotherapists, poorly trained and lacking skills. We designed and launched an Orthopedic Residency program for 24 physiotherapists at Black Lion Hospital. We recruited faculty from the USA. 

In 2011 we were attending a conference in Amsterdam and met someone I taught in Kenya as a Peace Corps volunteer. He invited us to Kenya to see if we could upgrade practice there. We established an Orthopedic Residency program there and have also developed programs in all aspects of physical therapy. That led to a relationship with AMREF International University.

Last year we received an invitation from a University in Mozambique to assist in developing a program there as well. 

I have spent 50 years treating people with physical disabilities. I realized early on that the best way to reach more people was to teach physical therapists the techniques they need to treat effectively. When we decided to offer a service opportunity for our staff of physical therapists an international opportunity seemed most appropriate. As a Peace Corps volunteer in Kenya in the late 70's and through extensive international travel through the developing world I have seen clearly the lack of modern education of practitioners and the lack of effective treatment for people with disabilities. I am not exaggerating when I say that the result of insufficient care to people in need in the developing world is horrific. The orphan beaten with resultant brain injury who lies in bed for years is one small example of millions, (he now walks). Travelers see some disabled crawling but they do not see what is behind closed doors. Our Foundation has been able to change the practice of physical therapy in two countries through sustained education. We are reaching the forgotten and the neglected. In the scheme of things it does not take a lot to make an enormous change in human lives.

I have been a physical therapist for 49 years. During this time there was a revolution in my field. I was an active participant during the transformation of the practice of physical therapy. 

In addition to clinical practice I have been a researcher, teacher and innovator. I have spent decades presenting my research and post graduate courses nationally and internationally. During this time I have come to know leaders, educators, researchers and progressive thinkers in rehabilitation medicine. Those connections and my reputation have enabled me to recruit Universities to help with curriculum development and to recruit the finest educators to send to Africa. I do not have to "sell" volunteers about the validity or integrity of the program they are volunteering for. 

My educational background enables me to help design and to assess the content of the curriculum presented to our hosts. My research background is helpful in designing and participating in the development and execution of research studies that validate the outcomes and effectiveness of our programs.

My history as a Peace Corps volunteer at Kenya Medical Training College, (KMTC), in Nairobi made entry into their educational system infinitely easier because, again, I was a "known" quantity. Our relationship with AMREF International University in Kenya was made possible because the Vice Chancellor was my co-worker when I was teaching at KMTC.

Finally, my knowledge of the needs of disabled populations in under-served countries enables me to develop very targeted and effective educational programs. 

Ethiopia has been a series of challenges for our program. In their system Medical and University Administrators change every two years. We started an Orthopedic Residency Program in physical therapy in 2011 at Black Lion Hospital through a Memorandum of Understanding, (MOU), with the Dean of the Medical School. Two years later the new Dean, upon learning of our program, shut it down. She would not recognize the MOU signed previously. We responded by developing a curriculum for a doctoral program in physical therapy which was approved by the University. We agreed to supply teachers under a new MOU. 

Three years into the program, with a new administrator in place, we needed to renew the MOU. He refused to sign saying that our program was classified wrong. He ignored that the University Senate had insisted on the classification we used. He said that they had made a mistake. Our program, the first of its kind in Africa, would stop without his signature. We worked to change the entire MOU to his satisfaction, altering the program in the process and secured his signature the next day. At the end of the year we graduated the first  17 DPTs in Africa.

Two years ago I felt that the 120 graduates of our Residency program in Kenya needed to get together and formally organize. I scheduled a symposium and invited all graduates to attend. During that meeting I spoke to them about the need to create an organization with an administrative structure, with dues, bylaws, mission, vision and goals. They have something special, an Advanced Diploma in Orthopedic Manual Therapy. Organizing would define their status within their profession. It would give them political leverage to negotiate with the Ministry of Health to recognize their unique knowledge and skills. An organization would formalize and protect their place in their profession.

I did not hear anything further over the next year and thought that the idea was dead. 

I returned to Nairobi one year later and met with our key Kenyan graduates. They announced that they had just attended the Second Annual OMT Symposium which they had independently organized.They elected officers, voted on bylaws and set goals for the year. I was astonished and very proud of them. They were inspired to act and had not asked for help. Since then they have also taken leadership positions in their national organization as well.