A whole day with AP in my thoughts

"Lower Bavarian clinic with clear blue skies"
March 5th 2011

On 1^st December 2010 I wrote a posting about some articles that I have, written by András Petö:

www.susie-mallett.org/2010/12/from.html

Below is a snippet of what I wrote there:

Sanatoriums and clinics, remedies and cures

András Petö was working in Austria where clinics and sanatoriums were not only the places where sick or recovering people spent time but also where well people spent time to prevent illness, or new symptoms, developing. This is very much how it still is here in Germany.

A close friend of mine is in such a clinic in the lower hills of the Alps at his very moment. She is not ill she is on a course of preventative treatments. Including psychotherapy, walking, art therapy and clown therapy. She has physiotherapy, meals are nutritionally worked out for her own personal needs, and the regime is strict. If she does not appear for breakfast dinner or tea someone is out looking for her and the doors of the clinic are locked at ten pm!

All this goes on for six whole weeks and is paid for by the health insurance company. A.P. mentions in one of the articles in my hands that there was the need for health insurance to pay for such healing and preventative measures.

Many of the treatments still in use in clinics here today have much in common with what AP describes in his books and in these articles. Kneipp treatments, Schüßler Salz and the use movement baths, to name a few.

What in the English language would probably be described as alternative medicine, even by some as quack medicine or snake oil remedies, are often the first treatments used in rehabilitation clinics, sanatoriums and also by the local GP.

Today I visited a clinic in Lower Bavaria that was built between 1898 and 1908, when it was opened as a tuberculosis sanatorium. It was built away from civilisation, as this was considered best to discourage the spread of TB.

It was set into the side of a hill, as the fresh, cold, air of the Alps was also thought to be beneficial for the healing and the well being of the clients.

Today the building remains, from the outside anyway, almost unchanged, despite additions and renovation over the years. It has changed hands several times but has always remained in use as a rehabilitation clinic.

Many of my stroke clients spent several months here after being discharged from the hospital where they spent the first few weeks after their stroke. Most of the clients I know who stayed in the clinic were there until they could take a few steps unaided, and a few of them have since returned for further weeks' rehabilitation.

I was not there just to visit my stroke clients

Two of the clients from my after-work adults' group had decided to take the four-week Kur (rehabilitation) that their payments to the health insurance company entitles them to once every two to four years. The insurance company, once it has accepted the request for rehabilitation, suggests which clinics can offer the most suitable therapies and activities for the clients. My clients asked whether they could go together, and this clinic in Lower Bavaria was suggested as being beneficial to them both.

Many people never take up this entitlement, and for one of the two I met today it was their first time at such a clinic. They are both enjoying the time there. They do not have to go to work but their days are very full. Some days there have been six different appointments from swimming, physiotherapy, massage, cognitive training, speech therapy etc., with breakfast lunch and supper also to be fitted in.

With this busy timetable they are learning to organise themselves and to be responsible for their own lives, there being no one around to take the responsiblity for them. They have no one to keep appointments for them but themselves.

I had decided to visit them on Saturday for two reasons. One of the clients was celebrating her birthday. Her parents are on holiday and therefore could not visit. I thought that it would be nice to surprise her and join her for coffee and cake, which is exactly what happened.

Secondly, the clinic has connections with Hungary and the my client’s doctor in charge knows about “Petö”, so I was interested to find out more about this. There are of course no doctors available to speak to at the weekends but I could still get a feel of the place and pick up some brochures. I discovered no mention of Petö and only a bit about the training of doctors, in Hungary and in Hamburg.

The clinic belongs to the Asklepios group which are based in Hamburg where it lecture rooms for the medical school that works together with the Semmelweiss University in Budapest and training courses for many other professions.

This clinic in Bavaria is described on its Website:

The Asklepios Clinic lies on the edge of the Bavarian Woods. The building sits on the side of a stone out-crop called Haussteins. There is a view over the Danube Plain and on clear days the Alps are visible in the distance. Surrounded by natural forests and is often described as the Bavarian Davos (ski/rehabilitation resort in Switzerland). The climate in the area is particularly beneficial to recovery, convalescence and general health.

I have read repeatedly in the several articles that I have in my procession and also in Unfug about András Petö’s experiences in clinics such as the one I visited this weekend.

In AP's time, and now

While I was soaking up the atmosphere I had time to imagine how it must be to work in such a clinic, or to be there for a month convalescing. I thought a lot about AP and about the different rehabilitation methods that he would have come across in his life while working in such clinics, and also about the many different illnesses and conditions that he would have encountered in each of the different clinics that he worked in.

I get the impression that not much has changed over the last hundred years. There is still a wide range of habilitating and rehabilitating therapies and activities offered, some more and some less controversial than others.

In the brochures that I picked up I read that today’s clients can benefit from:

Massage, traction, movement therapy, movement and medicinal baths, physiotherapy, inhalation therapy. Psychotherapy, warm/cold therapy, body-dance therapy, occupational therapy, speech therapy, training for incontinence, dietary advice, electro-therapy, psychological counselling, pain therapy, advice for health and well-being, for reducing the risk of further occurrences of illness.

Swallowing therapy, sport therapy, special therapy in the centre for mobilisation, (walking), therapy to improve balance and reduce dizziness, riding therapy, chiro-practise, nerve therapy and acupuncture.

Natural healing processes, relaxation methods, social advice, creative activities and art therapy.

That list reads a bit like the contents pages in AP's Unfug!

When I saw this list of therapies available now I thought about how AP would have experienced so many different approaches wheile he worked in Austria in different sanatoria, and of how many years later he went on to include many of these approaches and methods in the Unfug.

Well-being

The approach to rehabilitation in Austria in AP's days and nowadays in Germany too, has changed very little. Now as then in AP's days, the aim of the staff at the clinics and sanitoria is to treat the clients not only for the illness and symptoms that they have but at the same time to help them to learn how to live healthily. It is the aim to prepare them in methods of prevention at the same time as healing. Clinics aim to provide clients withn as many opportunities while they are in rehabilitation to bring their whole state of being in balance in order to achieve a state of "wellness". Clients work towards regaining their strength, and not just their physical strength, but social and psychological strength too, so that they can return to taking take an active part in their chosen lives.

I wandered through the clinic and I wondered

AP learnt and observed much in his early working life. He lived and worked in medical/ rehabilitation culture (in Austria), that put huge importance not only on curing illness but also preventing it. They were aware of the importance of well-being and of treating a client, not only specifically for tuberculosis and other illnesses but for training the body and soul to live healthily in the future.

As I wondered as I wandered I thought that it is hardly surprising that András Petö, when working alone in Hungary, developed a conductive approach to his work, an upbringing that is preventative and rehabilitative.

Back to the present day

It was a joy for me to visit my clients and experience their own enthusiasm for the restorative atmosphere that they are living in. with the minimum of help, with the greatest amount of independence, and with a programme that that is restoring their energy, stroking their souls and perhaps also improving their mobility. Most of all, it is doing their social and psychological development a power of good.

Notes

Susie Mallett - A.P. again, just before Hong Kong -

http://www.susie-mallett.org/2010/12/from.html

Early references in my blog to the Unfug, (there are many others) -

http://www.susie-mallett.org/2008/03/book-of-shenanigans-or-triumphs-book-of.html

http://www.susie-mallett.org/2008/03/conductive-soul.html

Karl Otto Bärnklau (1965) Unfug der Krankheit—Triumph des Heilkunst, Hannau/Main, Verlag Karl Schustek

Rehabilitation clinic –

Its logo includes the words “Prevention and wellness, together towards health”.

The Asklepios Group and Semmelweiss University offer medical students from Hungary and Germany the chance to study in Budapest and in Hamburg.

http://www.reha-hospital.de/bayern/niederbayern/asklepios-klinik-schaufling.html#Reha-Hospital-Beschreibung

http://www.asklepios.com/

http://www.asklepios.com/ams_Ueber_uns.Asklepios?ActiveID=3505

Davos -

http://de.wikipedia.org/wiki/Davos

Rehabilitation

by Susie Mallett March 2010

There are lots of different opinions

Most of my clients at some time or other go for several weeks at a time for rehabilitation at a clinic that specialises in the illness or symptoms that they have.

This is how the German health system works. There are clinics all over the country specialising in different treatments and cures for ailments. The individual health insurance companies favour certain clinics over others, even own some of them, and give their clients choices of two or three when their application for such a service is accepted.

There are also clinic where patients go for convalescence after a stay in hospital. This is prescribed by the patient’s doctor and is automatically paid for by the same health insurance companies.

Dr András Petö was the medical director in such clinics during the years that he lived in Austria. This was before he began his work in Budapest. His book Unfug der Krankheit: Triumph der Heilkunst“, written under the pseudonym of Dr. Barnklau, is full of examples of the treatments that one can still find in such places. The Kneipp and Schüßler cures for example.

Back to nowadays

Children go for such a Kür with their parents, sometimes the mother or father gets treatment or therapy too, sometimes not, depending on the personal health insurance and the clinic, and the GP who is recommending it all. Mother-and-child cures, as they are called, are no longer so readily available as they were fifteen years ago when I first came to Germany. Mothers could go once a year with their disabled or not-disabled children to experience massage, psychotherapies and physical therapies of all kinds. Often this all takes place beside the sea.

The clinic is chosen by the health insurance company and they are often a long way from home. How often one is allowed to go on such a Kür depends entirely on what the insurance company is prepared to pay for and what the illness is. Sometimes people can receive this treatment annually sometimes once every two or three years. Sometimes not at all. Carers are also offered these cures by some health insurers.

Not all of my clients take up this offer of being an in-patient for a month or more. That is a month away from home in which they could receive different treatments, try out new drugs or diets and experience knew activities such as qi-gong or self hypnosis/meditation, that are both popular at the moment. They could also take the opportunity to swim daily, have massages, speech therapy, physiotherapy, take part in Nordic walking, listen to lectures, and much more.

The different client groups that I have return from such a stay at a clinic with very differing stories to tell of their experiences. I have noticed that their opinions about the quality and benefit of these stays is very much influenced by their family status and the disability that they have.

The majority of my MS clients are single. Some were married and have families but are now separated and living alone. Others are single, never having been married. Some, having discovered they had MS in their twenties or thirties, then found that socialising, meeting prospective partners, even just making new friends became very difficult. Often they have become very isolated from the social environment that they knew before. Most of these clients like go to a rehabilitation clinic once every twelve months and they usually opt for the two-week extension that they are often offered. These clients enjoy the break from looking after themselves, from cooking and organising their households, as well as the daily physiotherapy, massages and social events that they are offered. Most of them attend specialist MS clinics where they will be informed about all the latest research and different drugs and treatments being given to patients with MS. Many arrange to go each year at the same time, so they can meet up with old acquaintances.

Nearly all of my MS clients return home from their rehabilitation satisfied with what they experienced. This is also true of the clients with cerebral palsy, both the adults and the children who attend with parents. It is however not always the case with my stroke clients.

Most of these stroke clients have families and, although they realise that when they are in a rehabilitation this also gives the rest of a family a break from being carers, they are not always satisfied with what they receive there.

One of my group returned last weekend from five weeks away from his family. Although he admits that in some areas of his life he has made good progress during this time he was very pleased to get home and back to his old routine of conductive education, physiotherapy, speech therapy and living with his wife and two teenage boys.

On the one hand he realises how important this break was for his wife and his sons, who have all cared for him for over a year now since the stroke. On the other hand he know that he is fit enough to have been more active and wishes he had been offered more hours of treatment. He feels that he could have improved his abilities much more given the encouragement and the opportunity. He indicated to us that the amount of therapy and activities that he was offered on this cure was no more than he got directly after his stroke when he was still ill. He is so much fitter now and would have been able to take part in more than the two activities each day that were available to him.

When he is at home he has his family to practise his speech with but when he is in rehabilitation after his activities are over for the day, apart from meal times he felt he had no one to practise his communication skills with. He still cannot speak at all spontaneously which makes it difficult in a clinic that is full of stroke and aphasic patients, to strike up any conversations and develop friendships.

Another client was an in-patient in the clinic where she was given botulin treatment in her right arm. The clinic would not give her the treatment unless she stayed there for three weeks. The only therapy that she received each day was an hour of physiotherapy each morning. For the rest of the day she was left to her own devices, which was mostly reading as she was unable to go far on her own. Her husband worked full-time several miles away, so he was unable to visit her, except for at the weekends.

This client argues that she could have had an hour of physiotherapy each day at home for three weeks and had the practice of using her arm by doing all that needed to be done in her household instead of staying at the hospital, where she was lonely and quite unhappy with her lot. She said that the money spend on the in-patient treatment would have been enough for her conductive education sessions for the whole year!

I think that in this case it the deciding point was the huge difference in the costs that are all paid for by the health insurance companies. The clinic will only do some treatments to in-patients because they get paid so much more.

Both of these examples are instances where stroke client did not feel ill or in need of a break from their daily lives. Both were recovering their fitness and wishing, indeed expecting, to be motivated to do more to develop their motor skills and independence and in one case his speech. They really felt like their time had been wasted and that they would have been better off had they been offered more intensive, daily treatment at home. One lady always says that she would rather that the health insurance company paid for a block of conductive education for her than pay for in-patient rehabilitation again. But it will be an uphill battle to persuade it to do this.

There was a clinic during the 1990s, not too far from Nürnberg, that had conductive education as part of its provision for disabled children. I worked there on one occasion as did many of my colleges working in Bavaria. This clinic has unfortunately been closed for several years, the whole clinic not only the conductive part of it. In its time it was one of very few places where parents could receive daily sessions of conductive education for several weeks a year, all paid for by their health insurance company, including the accommodation. These were among the families who were happy with the rehabilitation cure that they were offered.

Notes

Read a little bit about Kneipp and Schüßler and you could get an idea about some of the content of Dr András Petö’s book - Bärnklau, K. O. (1965) Unfug der Krankheit: Triumph der Heilkunst, Hanau/Main, Verlag Karl Schuster

Kneipp, “Through its holistic therapy concept, the classical Kneipp treatment brings about harmony between body and soul. This comes about naturally thanks to the curative powers of water and plants, through individual exercise therapy, through a balanced diet and orderliness in one's rhythm of life.” -

http://www.kneippaerztebund.de/html/history.html

http://www.koetzting.de/121.html

Schüßler, "Schuessler came to the conclusion that missing inorganic mineral salts will cause disruption to the living processes and therefore create illnesses" -

http://en.wikipedia.org/wiki/Biochemic_cell_salts

http://www.biochemic-cell-salts.com/12-tissue-salts/dr-wilhelm-heinrich-schuessler-1821-1898/

Petö Methode - das Wunder für Spastisch Gelähmte

"The shepherd's delight" by Susie Mallett, 2008

I planned the day so that lunch would be early and I could settle in front of the television in time for the "Midday" magazine at 13.00.

I asked one of the youngsters to sort out the technical stuff for me, like switching on a television and finding the right channel, and we settled down to our fish dinner.

It is Friday.

I made it in time

The presenter said early on in the show that they would be discussing this that and the other, the "other" being a report about a “therapy for people who had problems with their muscles”. At this point I was less optimistic then I had been earlier.

At 13.20 a storm that seemed to be brewing up caused the television to show nothing but snow. We quickly fiddled with knobs but in the end had to move to another TV, in the hope that the report had not been shown in the minutes that we took to reorganise.

Another twenty minutes then came the cue

This is roughly what they said in the introduction -

People who have a spastische Lähmung (spastic disability) were often tied to a wheelchair but then a Hungarian doctor came along, Dr Petö, and they stood up and walked. A miracle was taking place.

Yes this is how the introduction went, well, something along these lines. You can check it out on the link below, unfortunately I still can’t get the sound to work so I can not translate word for word.

The insurance just won't pay

The film went on to show Mario Schumacher and his mother in their home. Mario was showing us how far he had learnt to walk and his mother was explaining how the Petö-Methode had helped them gain some independence in their lives.

The aim behind making this programme was to bring to national attention the problem that the health insurance companies do not pay the cost of Conductive Education.

This family has debts of thousands of euros, the price paid privately for Mario’s increased independence, because the health insurance companies refuse to pay for it, because it isn’t in their “Book of approved provision”.

These companies are still looking for the written proof that it works. They do not believe their eyes, or the words of the people who experience it personally. The word Studium appeared again, as is usual in such reports.

The health insurance company in question (DAK) did not want to talk about individual cases, which suggests that perhaps the Schumachers are not the only family putting on the pressure.

It was a surprise when I saw this family. I had actually known that this film was being made. I had been invited a few months ago to help with its production. The charity that I work with in Nürnberg had offered help too, by covering my costs, both travel and time, and by providing any information needed for the programme. I hadn't heard any more, though, until today.

The report moved from the Schumachers very briefly to Würzburg, with some shots of children “walking” in a kindergarten session, and Wolfgang with a very short spot.

On the whole it didn’t say an awful lot about the "miracle" Petö Methode, certainly not enough to cause damage. The film had been made primarily to bring into the spotlight the position of many families in Germany, highlighting their struggle with health insurance companies. The families want financial support to pay for the method the they choose for their children with cerebral palsy.

The “Petö-Methode”

This could turn out to be a change for the better.

A change to a title that is far better than Konduktive Förderung, something that has been around since CE came to Germany.

Using this name could perhaps stop the immediate bundling of anything "conductive" into a specific drawer. The initial mention of the Petö-Methode would make no association to either education or health (though of course it would be best if pedagogy and upbringing were the words that we used here in Germany and that the whole thing was in the hands of the Education Department).

But for Frau Schumacher and the others who are fighting the health insurance companies for payment of Conductive Education perhaps the name Petö Methode might prove to be to their advantage.

Notes

Video of today's programe -
http://www.ardmediathek.de/ard/servlet/content/2880820