By Amy Keresztes
The course name is deceptively simple: Doctoral Physical Therapy 750, a service-learning course developed by the Scott/Ross Center and the Doctoral Physical Therapy (DPT) Program in the School of Nursing and Health Sciences.
Students are assigned to different service sites based on preference; ten students in the course volunteer with Hand to Hand, a program that offers hand massages to patients at the Barbara McInnis House, an inpatient medical respite facility in the South End operated by Boston Healthcare for the Homeless.
Dr. Jim O’Connell founded Boston Healthcare for the Homeless in 1985, and the network has since expanded to include full-time doctors, nurses, dentists and psychiatrists in over 80 locations. Serving approximately 12,000 individuals, it is the largest program of its kind in the U.S., and a model for similar programs around the world.
The Barbara McInnis House provides a compassionate solution for homeless individuals too sick to stay in shelters but unable to afford a costly hospital bed. In this healing space, students meet patients and engage in the simple art of hand massage.
Justine Beauchamp and David Simmons are third-year DPT students, Hand to Hand program coordinators, and volunteers. Their initial training for Hand to Hand reviews massage principles, therapeutic approaches to hands and muscle memory, stress reduction, and relaxation techniques.
However, once the students arrive at the McInnis House, the work transcends these technical elements of physical therapy. The experience is deeply rooted in the human connection.
“It’s all about the connection that you build with the person you’re giving the massage to,” Beauchamp said.
Understanding the unique experience of homelessness becomes central to the students’ service-learning experience.
More importantly, listening to their patients’ individual stories is an integral part of the process.
By maintaining curiosity and respect, the students encourage a mutual nourishment that deepens throughout the course of the therapeutic relationship.
“Going into it, I was nervous about what to say and what not to say. But all you have to do is let the patients guide the conversation—or lack of conversation—in the way that they want.
“Some people just want to sit with their eyes closed, and others want to tell me all about their lives,” said Simmons.
These lives involve rich histories, and may contain greater hardships than the students themselves have experienced.
Expecting an “old medicine” or linear provider-recipient relationship, Beauchamp was surprised by the reciprocal exchange, which she describes as “communicating with” instead of “giving to.”
What may begin as a service with an emphasis on professional limitations becomes an opportunity for naturally flowing conversation and relationship-building.
Since many patients choose to return, the opportunity to form a bond is an important one.
In addition to the verbal and emotional connection, the simple act of touch provides healing for both the patient and the therapist. Simmons describes the focused intimacy of hand massaging as a peaceful escape from the stresses of student life.
From a moral and philosophical perspective, Hand to Hand is a striking exception to society’s pervasive negative attitudes toward homeless individuals, who are often perceived as “the other”: a threat to our well-being, or merely a presence to be avoided. This is manifested in a physical tension when one is passing by or interacting with a homeless individual.
Sometimes, when describing the program in conversation, Beauchamp encounters that attitude.
The idea of massaging a homeless person’s hand can elicit a negative reaction, and she is often asked, “Do you wear gloves?”
The use of gloves in physical therapy follows a logical rule of thumb; if your patient does not have a contagious skin condition or open wound, you do not need gloves.
In Hand to Hand, the students do not wear gloves, just as they would for patients who are not homeless. If students are initially unsure of this, a consensus evolves as time passes and the relationships deepen. Regardless of the person, a hand is just a hand.
“I always tell people that it’s awesome,” said Beauchamp.
“We’re hanging out, talking, and it’s no different than me giving you a hand massage. It may be a different environment, but the experience isn’t different.”
Simmons like the response his patients give him about his hand massages.
“To see that big smile, to hear how much they enjoyed it and how much they look forward to coming back…that’s enough to keep me going.”
Another misconception is that the students are providing charity to homeless individuals, which undermines the collaborative nature of the encounter.
Both Simmons and Beauchamp are quick to point out that the experience of giving hand massages not only helps them learn and enhances their abilities, but also improves their days.
They remain hopeful about communicating the core of the work they do; after an initial negative or judgmental reaction, few people maintain those views.
Another surprise comes when patients assume that Hand to Hand is a requirement for students’ training. When they learn that the students are volunteers who choose to be there and to return each time, they are often surprised.
This type of response brings up the question of access to care in our society, which Boston Healthcare for the Homeless sees as a social justice issue.
Inherent in their mission is that everyone, no matter their circumstances, deserves quality health care.
On those South End streets where Simmons once felt tension passing by homeless individuals, he focuses more on the common humanity in those brief interactions. He is comfortable giving a smile and making eye contact with anyone, instead of looking down and speeding up, a tactic many employ.
As his experience with Hand to Hand has reinforced, homeless individuals are “people like you and I, who may not have a place to live.”
There is a dignity and respect inherent in acknowledging one’s environment, “which includes everyone in it,” Simmons said.
Expressing this can be as simple as David’s attention to body language and eye contact, or as loving as the hand massage.
Both students agree that being involved and invested in this environment has changed them.
They are determined to incorporate service of this nature into their professional physical therapy work, and the reality that marginalized and oppressed individuals lack access to services, has informed their view of the healing professions.
Simmons provides an essential framework for this kind of learning and growth; the bio-psycho-social-spiritual model is second nature to the curricula and programs of many programs and schools, as is an emphasis on the whole person.
This commitment is reflected in the fact that Simmons College is one of the nation’s only colleges to incorporate service-learning opportunities for graduate students. Within the practice of physical therapy, this ethos is “common sense” to Beauchamp and Simmons.
A hand is neither a disembodied part nor a model to practice on; it is always connected to an individual with a story.
As Beauchamp and Simmons welcome the first-year DPT students into Hand to Hand, they will emphasize that element, guiding them toward a greater understanding of the human beings who eat, work, and live with those hands, in the world we all inhabit.