Barbara Billek-Sawhney of Butler was last in an Ethiopian hospital in 1988. When she returned to it this spring, the intervening 24 years had changed them both.

Billek-Sawhney, an associate professor at Slippery Rock University where she teaches physical therapy, first traveled to Addis Ababa, the capital of the landlocked East African country, for Health Volunteers Overseas. It wasn't the most auspicious of times, she said.

Ethiopia was recovering from one of the worst droughts and famines in history. At the same time, it was fighting a war in an ultimately failed attempt to prevent its northeast province, Eritrea from breaking away to form an independent country.

Billek-Sawhney and her colleague, Karen Maloney Backstrom of Denver, Colo., didn't know what they were getting into.

“The country was at war back then, a civil war,” said Billek-Sawhney. “Back then, there were open sewers, police officers in the streets with guns to make sure order was maintained. There were a lot of animals on the streets. And there was the poverty.”

The two Americans, the first physical therapists volunteering through HVO, spent a month working at the 600-bed Black Lion Hospital.

“We thought it was an opportunity to teach and treat patients as physical therapists,” Billek-Sawhney said. “The organization was so anxious for us to go there that one orthopedic surgeon gave us each $1,000 toward our flight. We were wanted; we were needed; so we went to Ethiopia.”

There the two Americans treated many soldiers and others with neurological, orthopedic and other medical problems.

“We spent hours teaching the first Ethiopian orthopedic residents how to examine different joints such as the foot and ankle,” said Billek-Sawhney.

They also taught the one “physiotherapist,” a physical therapist, working at Black Lion and her technicians.

Billek-Sawhney went on to earn a doctoral degree in education from Duquesne University and her doctor of physical therapy degree from Chatham University.

She also married Dr. Raj Sawhney, an orthopedic clinical specialist, and had three children: Gabriel, 22; Isaiah, 19; and Tori, 17.

HVO later partnered with Addis Ababa University and the Jackson Clinics in northern Virginia to increase the level of physical therapy in Ethiopia.

HVO and the clinics coordinate therapists traveling to Addis Ababa to teach examination and treatment techniques at Black Lion Hospital, which is what earned Billek-Sawhney a return visit.

“There was a need, I was wanted, and I went back to Addis. Now Addis was never on my 'bucket list,' but the service was,” she said.

“It was great to have Barbara volunteer with HVO as a physical therapy volunteer in Ethiopia again — after 24 years. Her commitment to volunteering overseas, professional experience and previous trip to Ethiopia made her a huge asset to this program,” said HVO's April Pinner.

Billek-Sawhney traveled to Ethiopia this time with Deborah Gilpin, a physical therapist from the Jackson Clinics, and Kelly Wilson, a physical therapy student from Shenandoah University.

The first thing Billek-Sawhney noticed upon landing “was the change in local dress; so many people had abandoned the traditional, white, woven cotton clothing, known as the 'habesha qemi,' and the shiny, woven shawls, known as 'netela,' and instead wore western-style clothing.”

“There were also many high-rise buildings, very few animals such as goats on the street, and fortunately, an absence of soldiers and security guards with guns,” she said.

But the poverty persists, she added.

The Black Lion Hospital on the outside looked the same, if “a little more rundown,” Billek-Sawhney said.

But, she said, the hospital is now affiliated with Addis Ababa University and is a training center for nurses, medical students, numerous physician residency programs and now physiotherapists.

“In 1988 we were doing more patient care than teaching,” said Billek-Sawhney. “In 2012, when I treated a patient, there was always a group of residents with me. And there were lectures and labs.”

Billek-Sawhney's role was to further develop the skills of the physiotherapy residents in the area of neurological rehabilitation.

“Looking back, we did much more,” Gilpin said. “We had to change the cultural paradigm of long-term bed rest to heal illness and injury; this can lead to many secondary, life-threatening complications.”

At Butler Health Systems, where Billek-Sawhney practices, patients are commonly referred to PT the first day of hospitalization.

“In contrast, at Black Lion Hospital, a patient may lie in bed for one to three weeks before being seen by a therapist. By then, many of the patients develop secondary problems such as pressure ulcers, pneumonia or urinary tract infection. Early mobilization leads to less complications overall,” she said.

For Billek-Sawhney, the return to Ethiopia on behalf of the HVO followed a 2010 trip to Peru.

Already she is planning a trip next year to St. Lucia, an island country in the eastern Caribbean Sea.

“It was a wonderful experience, heading 'back to Africa!'” said Billek-Sawhney, who quoted Albert Schweitzer when explaining why she volunteers. “'I don't know what your destiny will be, but one thing I know: the only ones among you who will be really happy are those who will have sought and found how to serve.'''