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.
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