MONDAY 12/15/14

The plan for the next 4 days is to go out the various schools near by, and reach out to the community members, that might not other wise travel to Chidamoyo for rehabilitation services. Our main objective here is begin a network between Brighton, community health volunteers, and the families, to begin to recognize the types of disabilities that are in need here, as well as trouble shoot with Brighton on how he might approach treatment with these individuals.


After breakfast and devotion this morning, we met with Brighton in his Rehab Clinic to answer follow up questions to all the literature we provided him on Friday. He was so prepared, and even wrote up a list of ideas and plans he had in mind for our next GROW trip out to Chidamoyo. At this point, we were full of ideas that collaborated with each other about possible inservice, or teaching materials we could create to better serve, Brighton, the hospital staff, the community health workers, and patients/families.


MORNING ROUNDS: In the children's ward we had the young girl that was still admitted for osteomyelitis. She
demonstrated weakness, and subluxation of the affected shoulder. We brained stormed with Brighton on treatment ideas for her on a rehabilitation standpoint. Another update to the man who came in on saturday with the hand injury to the dorsum on this hand- caused by sheet metal. 90% of the his hand was exposed including finger extensor tendons. Having recently taken "wound care" all three of us were very enthusiastic about making sure that the nursing staff be aware that those exposed tendons be properly kept moisturized to prevent   deterioration of tissue. We explained to Brighton that ROM is important to gain, but the integrity of those tendons is imperative to that movement. Again we did not enter the TB wards, and enjoyed the sunshine as rounds continued.  Update on older woman who recently sustained a CVA- she was doing significantly better in such a short amount of time. She was walking with much more control and was able to demonstrate low squats- that would be required for using their "Blair Toilets" (squatting is very important for toileting here as described earlier) .  There was no significant update on the woman who collapsed in her home, and the MD had yet to give her a provisional diagnosis. She presented with weakness to her right leg, and loss of sensation to both limbs, 
but was slowly regaining it back.
 


TEA TIME
When we arrived back to the Rehab clinic there were about 6-8 people waiting to be seen.  All of these patients had to be cared for before we were able to head out to our community outreach. We worked on evaluations/treatments & education, for the following patients; young baby who suffered an injury to his right brachial plexus, A woman who fell last year and has a suspected meniscus tear, an older woman with low back, and knee pain, an older gentleman with low back pain, and a woman with a finger contracture from a fracture from many years ago.  With supervision we were able to break into two teams, with students leading the evaluations/ treatment session. It was such a great experience, to see and piece together contributing factors, and address what we could in that particular session.  At this point more people are joining the queue to be see, but given that we are already 1 hour behind we collectively saw one more patient. Our last patient at the Chidamoyo clinic was a 14 year old boy with cerebral palsy with poor trunk control, and limited sitting and standing stability.  We worked with by trial and error, and placed wedges under his heel- which greatly improved his standing  balance and posture! In sitting we worked on getting him to sit up taller, and encouraged him to raise his arms up high to catch & throw a ball- to improve trunk control and stability.  We left Brighton to take care of the last few patients in queue- and off to lunch at Kathy's we went!


Off to Bashungwe we go! 10 minutes in our car breaks down! Our driver called his mechanic, who showed up within 10 mins, and car was running within 5 minutes. We drove another 10 minutes, and our car breaks down again! Luckily our mechanic  had been following right behind us to make sure his work was successful ( what service!). We ended up switching cars with the mechanic so that we could get to our destination in a timely manner- which was the cherry topping.  We arrived to our destination and met "Anyways"- the village health worker, who was extremely nice and excited for our arrival.  We all worked together at the primary school to treat the 5 patients that arrived. Our first patient was a 4 year old girl with hydrocephalus, who's mother worried about poor head control. This was a good opportunity for Brighton to reflect back to previous cases we worked on with him, to demonstrate his ability to educate the parents on alternative head control positions. Our second patient was a 1.5 year old, who's mother's primary complaint was that the baby cant crawl, (theme emerges again).  Our third patient was a 11 year old girl  with cerebral palsy, decrease cognition, and a left bicep contracture. Brighton had previous worked with her, using a pulley system to regain her range of motion. We all collaborated on way that she would be able to actively regain that motion at home, such as  reaching to various points on a wall and with time slowly being able to reach higher and higher. Our forth patient was approximately 11 year old, with amblyopia in one eye and nystagmus in the other eye. His mother worried that we was weak, and falls a lot. When we worked with him, he had surprisingly good balance. For this particular patients there were some musculoskeletal impairments, but what became very apparent while working with him was a deficit in his depth perception. Our last patient of the day was short and sweet: poor boy had flat feet. We worked on simple foot intrinsic exercises like picking up rocks and stick with his toes and single leg stance.


Wednesday are the days they hold inservice trainings for the nurses, so when we got home, we drafted an algorithm that they could follow for -who is appropriate for inpatient rehab referrals.  Brighton mentioned being overloaded at time with referrals that were not appropriate for rehab, and we decided that a simple algorithm would help weed out, and also include patients who would benefit from his services.

JD and the Gang