Day #1 at Chidamoyo
After last's night hellishly long trek, Kathy gave us a sleep in pass for this morning- breakfast was served at 9:00 am, and we walked away from it, full, and caffeinated with arms up- yelling " WE ARE ALIVE".
The hospital is quite literally a stones throw away ( if you have a good arm that is), and we walked over soon after breakfast. Our first task was to re organize all the things we brought over in our suit cases; gifts for Kathy, Major, And Brighton. Orthotics, toys and gifts for the children we would be seeing, and adaptive technology equipment.
We took a quick tour of Brighton's rehab lab, which was a decent sized room with a high table, and shelved walls filled with orthopedic treatment equipment, a broke treadmill, a recumbent bike machine, and a corner filled with crutches galore. One of our missions for this trip was to share ideas and empower him to be able to continue treating the patients that come through Chidamoyo, especially the pediatric population. He mentioned time and time again that pediatrics was particularly difficult for him because he felt like he did not have the right equipment to be successful for peds treatment. When we arrived to his clinic there were 4 families already waiting with their children to be seen by him today. Unfortunately it was tea time shortly after meeting him, and had to return in an hr to begin seeing patients. Yes an hour a day is taken every day where everyone stops and has tea- cheers. Post tea time we all huddled to try to determine the best use of our, Brighton's and the families time during the remainder of the stay. Options were thrown around, splitting up into two- three teams- one student per PT/ rehab tech & conquer the 4 patients, or having one mega team. Mega team was agreed upon by Brighton and out selves, because at the end of the day it wasn't about seeing as many patients as possible, but more so giving Brighton the tools he would need to continue to treat these patients long after we were gone. Next week the plan is to visit the neighboring schools and provide outreach services to families with children of disability. The tentative plan was to continue as mega group and depending on the size of turn out, and needs of the particular families, to break into 2-3 teams
First patient of the day was a young girl around the age of one with hydrocephalus. She had shunts placed in about two weeks ago, and the mothers primary complaint was to crawl. Previously Brighton discussed with us what he thought to be his many failures with children was attempting to get them to crawl. Sara was more than reassuring to him that crawling is a difficult feat and by far much more complicated than walking in more respects and that it was not a failure on his part, and that she too shared that struggle. We discussed with Brighton and the mother that head control was a good place to start with a goal like crawling, and because of the added weight to her head, it would be a good challenge to begin to tackle. It was great to see Sara hone in on the mother and child day life dynamic to provide suggestions on positions she could put her baby in to begin developing head control. It was truly a great learning experience for both Brighton and "the royal we" ( Lauren, Melissa & myself). HEP (home exercise program) was delivered, and mom was able to demonstrate.
Second patient of the day "big smiles" was this adorable 4 year old boy with cerebral palsy with athetoid movements and smiles for days! His mother's primary goal here was to have her child be able to crawl. He was a great kid to work with because he was so aware of his body and he was able to pick up on the most suddle cues. He had the appearance of minimal head control, but he had a heavy relationship with head and eye directional movements. Kendra and Sara both pointed out that this child liked to be in highly stable positions, ie excessive head extension " eyes to the sky" and would stand with assistance in an extension synergistic pattern. We were able to show him, and mom was to catch his attention and help him control his head position with his eyes. We also got to do a lot of hand on, attempting to get him out of his extension synergistic patterns in assisted sit to stand. He picked up on this very quickly, and we later had a discussion that if this child had access to treatment from an earlier age, and continued aggressive PT treatment, there was no doubt that we would be able to walk with modifications. But out here the hospital is located so far away, and the adherence to continued visits is quite minimal, that the outcome is not as likely.
LUNCH- we went to Kathy's to have lunch. She served a beef stew of sort and sadza, which is a maize and water dish. She told us how here the belief is that if you don't eat sadza everyday you will die. This becomes an issue as you can image for those who suffer a CVA or other conditions in which aspiration becomes an issue, and many have died from being force fed to eat sadza to "stay a live".
Our third patient of the day, was a young girl, probably around the age of 2-3. Her mother's primary complaint was that she didn't crawl. By now you see a theme right!? We asked around later to try and figure out if crawling was a necessity in the culture for mobility. Before coming out here we were under the impression that children spent a minimal amount of time on the ground, and did expect that the developmental milestones would differ due to cultural norms. We wanted to know what was the purpose for crawling in their homes to better serve the families needs. We later found out, that each mother is give a baby wellness card upon birth, which states typical baby developmental milestones, and that they can track their children's progress as they go. I can imagine crawling is one that is not commonly checked off and it helps explain some of the visits. Lauren, Melissa, Sara and myself didn't get to see much of our third patient, because a nurse ran into the rehab room, and told us there was a live birth happening and that we should run over to see it. We quite literally ran out ( Kendra stayed with the current patient) and by the time we got there, she had already given birth. We did see the after birth, and no we did not touch the embryonic fluid!
When we got back, we had one more patient. She was an eleven year old girl with microcephaly. Her mother's primary complaint was that she was not very social and would occasionally lose balance. She was able to maintain a short amount of shared attention time, as we tossed a small ball back and forth with her. She was cognitively deficit which was a major factor to her mother's complaints. Recommendations were made to find things she likes to continue in shared attention, and keeping directions limited to one word. Balance could be worked on in her home environment where she could step over, or avoid objects.
At the end of the day, Brighton gave us a quick tour of the entire hospital. We got to meet a lot of the staff, and got to see Msasa, which is a waiting area that expecting mothers could come, prior to being admitted into the delivery ward. There were 2 housing areas that would typically hold about 4-6 women, but could "hold" up to 40, which is incredibly surprising given I estimate the sizes of them to be about 30x20 feet long. After our tour, we were all zonked out! We decided to take a quick hike about the area, before dinner. It is quite beautiful and the temperature was just right, sunny with a cool breeze.
-JD, Lauren, Melissa, Kendra, and Sara
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