If a native Haitian has a stroke or loses a limb to trauma or diabetes, he is lucky to get a few days of acute care in a private hospital or clinic, let alone any follow-up physical, occupational or speech therapy.

In Haiti, there are virtually no physical therapists or training programs, said Denise English, 57, a Turtle Creek-based physical therapist who has seen the situation up close as a volunteer teacher of rehabilitation technicians with Health Volunteers Overseas of Washington, D.C. "Until recently, rehabilitation hasn't even been a consideration.

"There are several reasons," Ms. English added. "The medical system is not well-established at all; there is no national health care; and the government infrastructure always has been unstable, so most hospitals have been private or clinics run through non-governmental organizations rather than public hospitals. Really it's all that can be done to meet the primary health needs, and those aren't always met very well.

"Because of the poverty there is not enough money to even stay in the hospital ... so a person with a stroke or an amputation might be sent home within a few days.

"Basically, they just disappear into the community. There's no follow-up. Amputees are prime examples -- if they were trained to get in and out of their wheelchairs, to get around on crutches, they could be referred to Port-au-Prince and fitted for a prosthetic."

Over the last several years, HVO has been helping to provide that training by teaching small classes of Haitians the basics of physical, occupational and speech therapy and nursing. Sponsored by such groups as the American Medical Association, the American Physical Therapy Association and the American Dental Association, HVO has trained five small classes of rehabilitation technicians in Port-au-Prince, Haiti's capital.

Ms. English is the program director for the Haiti project, making her responsible for overseeing and evaluating the training program, orienting faculty and refining the curriculum.

Now the HVO program is moving on to the Artibonite Valley in central Haiti, where it will provide three nine-month training programs over the next three years in partnership with two Pittsburgh-based nonprofits, Hôpital Albert Schweitzer Haiti and Friends of Hôpital Albert Schweitzer Haiti.

Ms. English heads to Haiti Nov. 11 to help choose the four students accepted for the inaugural HAS program, prepare the classroom and hire a translator. It is the first of at least three trips she'll make during each training session. All of the teachers volunteer their time and travel costs for these trips, although this time the Schweitzer hospital will provide room and board.

"I'm going to be there the whole month of January and the month of April to teach ... along with some really neat teachers, all of whom have taught in the program or have been involved extensively in Haiti," she said.

Ms. English has been traveling to volunteer in Haiti since 1998.

"I went as part of a small team of well drillers, construction crew, a nurse and a physician to a small town called LaCroix north of the hospital and about 90 miles north of Port-au-Prince," she said. Her husband, Dennis, an obstetrician/gynecologist at Magee Womens Hospital, also made that trip. They continue to go to LaCroix with that group yearly.

"I always had a sense that I wanted to work outside of the country and this came along," Ms. English said. "It was to see what the needs were and to see if I might be able to do something. ...

"I went for three years once or twice yearly, improvising physical therapy, and I realized it wouldn't be hard to leave skills. With more time I could train some locals there to do the work."

She got that opportunity in 2001 when Health Volunteers Overseas recruited her to travel as an instructor.

"I immediately recognized the connection I was looking for," Ms. English said.

"It makes me feel like I'm doing what I'm supposed to do."