Monday (Final day in Zimbabwe)

Today is the day to get some shopping in and head back home to Seattle. We have a long trip ahead of us, a full 24 hours of flying not including layover time. We have all had such an incredible experience on this trip and are already planning for when to come back! The people in Chidamoyo were all so friendly and welcoming and Kathy and Major welcomed us with open arms into their homes and treated us so well! We are very fortunate and grateful to have had this opportunity to come to Chidamoyo and help out at the hospital, work closely with Brighton with his rehabilitation department, and experience the culture and beautiful people here. We are sad to be leaving, but also excited to be home to spend Christmas with our families.

Thank you so much to Cheryl Kerfeld for being our main support system behind GROW and for encouraging us to make this trip possible! We also want to thank the entire University of Washington Rehabilitation Department faculty who has also supported us along the way.

A huge Thank you to Sara and Kendra, our amazing physical therapy clinical instructors, who jumped on board with the opportunity, even when this first GROW trip to Zimbabwe had some unknown expectations. We have gained so much from this experience with your guidance and appreciate everything you have done for us.

Last but not least, we want to thank our friends and family who have all supported us and made this trip possible with the help of your generous donations and kind words!

-Until next time,

Lauren, JD, and Melissa J

Safari (Fri-Sun)

We woke up around 5am Friday morning, had a quick breakfast and hit the road for Rhino Safari Camp. The drive to Karoi took about 4 hours and then an hour boat ride to get to our final destination. As soon as we arrived to camp, like hadn’t even climbed out of the land rover yet, one of the workers came over to us and asked, “you wanna see a snake?”…all of us but Kendra, who is not so fond of snakes, were excited at the opportunity. The guy brought the snake (XX) over, which was in the middle of a war with a gecko, both biting down on each other...we never found out who won. And that was the beginning of our safari!

This camp was so amazing…there were about 6 huts in the sand, each with two beds and a bathroom with an outdoor shower (possible the coolest shower we have ever taken in our lives). There was also a bigger hut with a common area upstairs and a bar downstairs with tables set up in the sand for dinning. In addition there was a bon fire pit where we would sit at night before dinner until a drumming solo by one of the staff summoned us for dinner.

Day 1: When we arrived on Friday it was later in the afternoon so we still had that evening to head out on the Land Rover and go search for some animals…and we found many! Elephants, impalas, tortoise, hippos, crocodiles, more elephants and more impalas, jackals, birds of all different beautiful colors, snakes, warthogs, kudu, mongoose, baboons, and more elephants and more impalas!!! We practically saw each of the Lion King members (Rafiki, Timon, Pumbaa, Zazu …..but no luck with any members of the cat family yet. After driving around for a few hours we stopped near the water and got out of the land rover to sit on a log nearby to enjoy our drinks and watch the beautiful sunset. We were probably about 50 feet from our vehicle when some elephants decided to come out from behind the bush and join the party. Long story short…the elephants came very close to us and most of us got a little scared because well these are giant animals and they have large tusks that look a lot scarier when you are standing twenty feet from them. We all stood still as our guide had instructed us to do, which was for about fifteen minutes but really felt like an hour. When the elephants finally decided to walk on and forget about us we all climbed into the land rover and headed back to camp. Yes this was a frightening moment for sure, but so special to be with such majestic animals in their natural habitat. After arriving back to camp…some of us still in fight or flight mode…gradually relaxed and enjoyed a delicious dinner, which consisted of butternut squash soup, ham and veggies, fresh baked rolls, and dessert. After a long day of travel and excitement of being out in the “true bush”, our guards walked us back to our huts with his shotgun in hand for protection, where we got to fall asleep in our beautiful rooms overlooking the water.

Day 2: Rise and shine was at 5am in order to head out early to hopefully track down some lions. Today was the day...we were on a mission to find those cats! Some hyenas had come through our camp during the night and Kathy had heard them, but they were gone by morning when we all got up and moving. The staff also rakes the sand each night so that you can see what animals may have come through during the night by their tracks. Today we headed out with Steve (our main guide) for about 4 hours before lunch. We searched different territories than the previous day and saw more and more of the animals we had seen before…but still no cats L We headed back around 10:30 for some lunch and break and decided to try a boat tour along the water in the evening. It was a beautiful night as we coasted along the shore, ever so often coming across more hippos, crocs, and elephants. Since it was getting to be dusk when the lions tend to come out more we were hoping to find them, but still no luck. Although we still hadn’t found them, it was a beautiful boat ride seeing the beautiful scenery and animals along the way. A thunderstorm was coming in tonight and we made it back to camp before the dark clouds came our way. We ended the night yet again sitting around the fire and with a delicious meal. The chef had heard how much we enjoyed sedza (a traditional African staple), so he made us some with a beef stew!

Day 3: Today was our last day. We had one more change to track those lions. We headed out early again, driving out to yet again more land we had yet to cover. Today Steve had his game face on. We would stop ever so often looking over the side of the car for tracks. It’s quite amazing what this man is able to do and how much they have to know being a guide. We were driving along and all had spotted a large group of voltures ahead…and we knew that was a sign something had been killed nearby…which means lions! As we got closer a horrible smell came over us and we stopped the car. Lion tracks and elephant tracks were everywhere. Steve got out to go investigate, where he came upon a deceased elephant, most likely killed by lions because he said it was by natural causes, which means not by poachers. He estimated the kill to be up to a week old. There were fresh lion prints, which he can tell by when it last rained how fresh they are, so we were getting close! Steve and JD got out to go investigate more on foot…but the rest of us were too chicken and decided to stay in the vehicle. After about 5 minutes they came back with no sign of the lions, so we drove on. Not long after we passed by an area where Steve had stopped and pointed out a distinct smell, that of a lion leaving its presence, almost like dogs marking their territory. We were right on their tails! We drove on and still no luck. We were beginning to lose hope that we would not get the chance to see them because at this point we only had about 30 minutes left before we had to head back to camp. So Steve says, lets try one last area before we head back. We drove into a big open field…and more voltures!!! BINGO! This time, the voltures were after a baby impala, a kill from a lion. After a few minutes Steve spotted the lioness lying under a tree in the distance. We drove up to her and she looked relaxed and happy as could be, probably relaxing after her meal. We sat there just staring at her for a bit and she stared back. Steve informed us that for the lions, it is hard for them to distinguish us as humans when we are in the car, because they only see the car. However if one of us were to stand up and make sudden movements, it would then recognize us as separate beings. Victory…we finally found our lion…and it was time to head back.

We headed back to Harare to stay the night so we could get up and do some shopping at the flee markets before heading to the airport on Monday. The safari was an amazing experience and a great way to end out trip with a little vacation! We would highly recommend this safari camp to anyone and would love to go back again someday!

Thursday:

Today is suppose to be our busiest and last day with Chidamoyo. We will be joining the nursing staff on their trip to Magororo during their well-baby immunization out reach clinic. We will be scouting for children there, who may benefit from Rehab services, provided by Brighton at Chidamoyo. We followed the same schedule, that we've been doing during our stay here, except we were scheduled to leave soon after Devotions, to head to town. After devotions Kathy stood us up in front of the hospital staff, so as that they could wish us safe travels. It was a very touching gesture, and Sara acted as our spokes person and reciprocated our gratitude for their hospitality and for the opportunity they have provided us.

 

Our departure was a bit delayed ( on time african time) so we decided to join rounds until our cars were ready to go.  We had 3 new patients- none appropriate for rehab. The young girl with osteomyelitis was sent to Harare, after receiving her x-rays which showed that she had a humeral head fracture.  We ran into the man who suffered from epilepsy (who we previously began walking with) with his wife and son, taking a little walk down the length of the wards. He was much more lively than he was the first time we saw him in rounds, but you could tell that he was very  tired at this point- shuffling his feet, so we all gathered around to ensure his safety back to his room.

As we were driving into town we saw a huge crowd surrounding a building, and we braced our selves for the day to come, but then we realized that people were shopping for the holidays and that crowd was not for us.   We arrive to our destination, and Brighton provides a quick announcement to the waiting mothers, as to our reason for being there- so if they had any concerns while they wait for their immunizations, they could queue up to see us. In the end our "busy day" boiled down to only 5 children, seen; 2 children with cerebral palsy- one of which had been undiagnosed till today, a few who had concerns with crawling, and one 4 year old with Erb's palsy. Brighton was especially excited about this particular patient, because of previous conversations we all had in regards to Erb's  palsy and how after 2 years of age, the rate of spontaneous recovery significant slows down.

We decided to help out the nurses with their process, since out load was so small. We divided an conquered, taking height, weight, and arm width measurements. The funniest part was when this 2-3 year old crying boy, was put into our height measuring box of sorts, and takes one look at Melissa, and yells to the tops of his lungs in pure surprise fear.  Once everyone was good and measured, we assisted the nursing staff, take record of everyone that showed up. It began to sprinkle and all the mothers with their children scattered to shelter. I'm still not sure whether they all received immunizations, before the rain began to pour!  We managed to pack up the two cars and hit the road pretty early.

We got back to Chidamoyo much earlier than we anticipated, so we decided to use that time to go over a short movement lab with Brighton.  We then went to check up on our older patients, who suffered from epilepsy, and the man who sustained a stroke, to work on ambulation and sitting at the edge of bed. We said our good byes to Brighton, and gave him our contact information so that he could keep in touch while we are away.  We took one last stroll around the area as a group to enjoy the sights and say our good byes (for now) to Chidamoyo.

Looking back, the time we spent at the hospital was so short, and we highly recommend that the next trip be at least 2-3 full weeks (not including travel time). We did however make good use of our time, and there was never a dull moment.  Tomorrow we head to Kariba for our last 2 days to go on Safari!!!!

Well Baby Immunization Day

12/17/14 (Wednesday)
We started our day with Egg Mcmuffins at Cathy’s house.  After we went up to the hospital for devotions and to begin our day we taught an in-service with the nursing staff at Chidamoyo.  The goal of the in-service was to focus on indications for referral to rehab and body mechanics focusing on transfers.  The prior evening we had developed an algorithm that outlined indications for rehabilitation.  This was developed to try to narrow down the patients that are referred to Brighton and help to decrease his daily workload.  We reviewed it with the nurses and ran through it using patients that we had seen over the past few days.  We then moved to transfer training.  One of the most common transfers is from rolling plinth (used to transport patients) to the theatre (surgery) table.  We reviewed body mechanics, sheet transfers and sliding board (which they have at the hospital but don’t like to use).  As well as educating them on the muscles and techniques that they want to use when moving pts. This seemed to be all new information for the nursing staff. It seemed to be well recieved as the staff demonstrated improvement, had great questions and seemed to take new things away from the session.


After the in-service we did rounds with the doctor.  Today we got to see the removal of a bandage over a snake bite in order to check if a skin graft took, discussed with the doctor the exercises we had done the prior day and future plans for two separate patients with CVAs and discussed a new patient who was presenting with generalized weakness, low hemoglobin, cough and a fever and they could not figure out what was going on.   After rounds we saw two outpatient kiddos.  One was a child who had been casted  to tight after a elbow fracture and had sustained several severe wounds.  This was 9 months ago and there was severe scarring leading to elbow flexion, wrist flexion and pronation contractures.  We educated and worked on scar massage, stretching, looked at splint options and fit to help with the contractures.   We also saw a 14 month old with CP who had seizures post birth and now has poor head control and problems regulating tone.  We worked with the mother to go over positioning and education.  After the two patients we headed to Mudzimba for our third community visit.
After an hour ride we arrived and there were 9 families waiting to be seen. We split up into two teams and worked with the village health worker who spoke English as well as Brighton in order to help with translation.  The patients included; down syndrome, spastic quadriplegia, CP and developmental delay.  We did lots of education, gait training, balance exercises, positioning, transitional movement training and transfers.  The community health worker for Mudzimba was Topson and he had been in this position since 1984. He was such a wonderful man, so eager to learn, help and assist the families.  He was also a huge help in translating as he spoke both Shona and English, allowing us to better assist the families in a timely manner.

After returning from the hospital we saw three more patients back at Chidamoyo.  We put on another plaster for a girl who had an ulna and radius fracture.  As well as revisiting both the patients we had seen earlier with a CVA.  The first gentlemen with a CVA and dementia we did gait training again, this time with a front wheeled walker and continuing to work with the wife on guarding and cues.  The second pt with a CVA had not sat up in 2 weeks and had developed a pressure ulcer.  So we did a screen, gentle range of motion, PNF and then had him dangle at the edge of the bed for a few minutes.

After another delicious dinner at Kathy’s we had another Christmas activity with the hospital….we went Christmas caroling, singing songs in Shona.  There was a group of about 10 of us that started up at the hospital.  We went to each ward/room and would sing a different Christmas carol and then end with “We Wish you A Merry Christmas” (in English) as one of the children passed out candy to everyone.  Then the tradition is if you are able (family, patients, workers etc.) you join the caroling group and continue on.  After the hospital we went out and did the expectant mothers area (Msasa), then hospital workers and families houses.  By the end of caroling there was probably a group of 30-40 people that had joined us.  It was a very special evening full of singing, laughter and Christmas cheer.  Even though we were in 70 degree weather in Africa, far away from home it definitely made it feel a little more like Christmas. After caroling we headed to bed knowing we had a busy and early day ahead with the Well Baby Checkup and our last community PT visit.

Sara talking to a mother and father about positioning for facilitating head control.

                                   Inservice with the nursing staff working on lifting mechanics and transfer training

12-16-14 (Tuesday)

Today started off with a delicious French toast breakfast at Kathy’s followed by devotions at the hospital at 7:30 am. It started to downpour this morning and didn’t let up until around 1:00 pm. Our plan was to leave around 9 am to head out to Rengwe for an outreach clinic to see children in the nearby villages but decided to wait until the rain let up, and instead did inpatient rounds with Kathy and Brighton. During rounds we came across a man with epilepsy and some cognitive deficits who had been defaulted on his medication and had not walked since March. JD, Melissa, and myself did a short evaluation on him, which consisted of assessing his bed mobility, getting him up into sitting, and checking his active range of motion of the lower extremities. Because of his confusion performing manual muscle testing was very difficult. He presented with lower extremity muscle atrophy on one side compared to another and was very timid to put weight on that side once we got him up into standing. We worked on weight shifting while I provided moderate assistance and had him take a few steps forward and back to assess his walking. This man clearly needed an assistive device so we decided to try both a FWW (front wheeled walker) and a pick up walker. Both were challenging because of his cognitive deficits and confusion and he needed many verbal and manual cues. We taught his wife to walk with him safely but only with another person for assistance because he had a high risk of falling.

After rounds we had tea time with Major and enjoyed some freshly roasted peanuts and coffee then headed out with Brighton for our outreach clinic to Rengwe, but unfortunately when we got there, nobody had showed up. The weather most likely kept people from coming out today because although the rain had stopped, this was a prime time for people to work in their fields.

Upon returning we headed to work in outpatient rehab at the hospital with Brighton where we broke up into two teams to tackle treating more patients. JD and myself evaluated two middle-aged women, both with complaints of knee pain and presentation of swelling and muscle atrophy. We assessed stairs and squatting, especially since the blair toilets require a deep squat position. We helped correct squat body mechanics to decrease pressure on the knee joint and educated them on performing active range of motion and strengthening exercises after awakening. In addition we told her to use a walking stick for long distances and wrapped her knee to help with the swelling during the long workdays out in the fields. Our last patient for the day was a young boy with a left femur fracture who had just finished his one month of traction and was ready for his cast. JD, Melissa, and myself performed our first casting with the guidance of Brighton and Kendra J

After work we headed out on a short walk before dinner. It was a beautiful evening and A LOT of people were out working in their fields. I don’t think I have ever seen so many goats, cows, pigs, chickens, and donkeys in one area before!

We got to enjoy a Taco Tuesday dinner…they treat us VERY well here…followed by the beginning of the hospital’s Christmas festivities…outdoor movie night! Michael and Wayne (Major’s son and nephew) set up a projector outside of Kathy’s house and people from the community were welcome to come and enjoy “The Santa Clause” movie. Brighton came with his wife Joyful and two sons Believe and Ballad and they were so precious! The sky was clear tonight and the stars were out in full effect…possibly the prettiest stars I have seen yet! We also got to enjoy watching all of the lightening bugs that were out tonight. Our movie snacks consisted of delicious fresh mangos that we picked earlier that day…which are in abundance here and I am very jealous about! I also had brought dried mangos from back home and had Major’s kids try them for the first time and they loved them…trading dried mangos for fresh mangos J

After movie time was over it was bedtime for sure! Power is still out because of the rainstorm, so hopefully it will get back up soon…for now its headlamp time.

P.S. They also have awesome thunder and lightening storms here! (BANANANA)- Thunder in Shona :)

-Lauren, JD, and Melissa