Kenya 2018 Clinic Mentoring: Travel Day

Excited for this next adventure!
I am headed to Nairobi, Kenya through The Jackson Clinics of Northern Virginia. I had the pleasure of learning from the owner, Richard Jackson, while in PT school and continued a relationship during residency and fellowship training. When he approached me with the opportunity to mentor Kenyan therapists in orthopedic manual therapy I could not contain my excitement.

After a year of planning and preparing the day is finally here to travel to Kenya. Another one of his employees, Emily, and myself will be mentoring 18-20 physiotherapy students for the next two weeks.

To make this experience even better, SUPT Thrive, the student lead medical mission trip group at Shenandoah University will be also on the trip. Four students from the program will be working alongside and mentored by Kenyan practicing physiotherapists. The model for this trip is amazing with Americans mentoring Kenyans and Kenyans mentoring Americans!

We will be traveling for 17 hours and arriving in Kenya on Sunday afternoon.

Looking forward to mentoring, making new friends, exploration, self reflection, and self growth.

Travel Home

4:20 AM wake up call.
Got packed and spent one last morning on the dock enjoying the sunrise.

At the gate now to leave Honduras for Atlanta.

It has been a great week of learning for myself and I think I can speak for the whole group that we all learned a lot.

We each made a goal at the beginning of the week and reflected on how we reached that goal last night. My goal was relationships: improving my relationship with students as I grow in education, with my peer clinicians, with the patients, with my goal of global health, and myself. I feel that this week I made some great strides in all of these areas, but can still improve in many ways. I look forward to the continued growth and reflection as I head back to Chicago for the last 6 weeks before being able to move back home with Olivia!

I hope everyone was able to enjoy the week as much as our Thrive group did!

Sunday Day 2

We managed to travel my air land And sea yesterday.  After the two flights we took a 3 hour bus ride across the country boarder and ended with a 20 minute boat ride to El Faro where we are staying.   This compound is an amazing facility which hosts over 30 American medical, mission, and education groups early as well as 150 Guatemalan groups each year.  I was blown away by the buildings and how nice everything was.  Having the water right on our doorstep was amazing too! 

The coolest part of my day was getting off the plane and hearing my name called in the arrivals area of the Honduras airport.  It was crazy, but the only peeps who I know that lives in Honduras was as the airport picking up students for the Student Helping Honduras organization! It was amazing to see Jessa at the airport. I had not seen her in a long time but I was happy to catch up.

Everyone was pretty tired from the full day of travel so a few of us talked on the deck for an hour but everyone was asleep early the first night.

Sunday started my favorite way.  Woke up to the sounds of the animals and sunlight in the window.

I went on a nice run in the AM and even got to workout.  Breakfast was a great meal prepared by the staff at El Faro. I can tell we will be spoiled all week.

After breakfast we got a tour of the campus and learned about the mission and great works they have been doing in the community from water to education to medical care and social development.

After the tour we were lead by John in a team building activity which we crushed as a group. I would recommend after this experience that one of the first things all groups should do are physical group challenges.  In 1.5 hours we really go to learn about each other and helped bring us together.

After lunch we got to participate in another pillar of the organizations mission working with children during a bible study. We played games, did worship, assisted with the needs of the teachers, provided snack, and more playing.   I enjoyed this experience with the local children, getting to know them with basic broken Spanish, play, and touch.  It's funny how no matter what culture or where you are in the world, every 7 year old kid will try to scoot close to you and touch your leg when you are sitting next to them.  It's amazing how effective you can show affection and caring with a simple hug, high five, or toss in the air! 

We spent a little time in the water in the great weather before the rain came at night.

After dinner the group did a great job reflecting and preparing for the week ahead.  We are all eager to get into the clinic and begin to work with patients and local therapists.

Day 8 Adventure Day

Another morning run and workout follow up by the best breakfast so far. My favorite thing... breakfast burritos! Not anyone loved them as much as I did, but I can't complain because I got all the leftovers.

Here is a picture of the cross that sits on the edge of the El Faro property overlooking the dock. 

The group was supposed to go back Livingston down the river to a waterfall/hot spring today. 

However, since Tuesday I have known that Tommy planned for us to go to Belize instead as a surprise. Instead of telling the group he decided to wait and tell them when we got to land.

Already knowing the plan I was shocked that people did not speak up when we started taking a new route and had snorkeling gear in the boat. Luckily everyone did not pick up on these hints and just took the 1:45 boat ride in stride. Once we got to crystal clear water and small islands he told the group. Everyone was in shock and awe of the secret, landscape, and weather.  We got to snorkel on some small reefs and even an old shipwreck. After a few hours we docked and ate some packed sandwiches and reflected on the trip.

 

(this is over 15 feet deep water)

We got to go back to Livingston one more time to get anything we needed.

I was most excited about trying a Gallo which is the number one Guatemalan beer. At El Faro there is no drinking, so I had not tried the homegrown beer on the trip yet. Perfect finish to a great day.

We finished the night with a great dinner, reflections, and watching highlights of the trip.  

We thanked the whole staff for the support this week with Thrive T-shirts and enjoyed our final night in Guatemala.

We have to leave for the airport at 5:45 am because of the long boat and bus ride. 

Day 7 Final clinic day

One thing I forgot last night was the shooting stat that 3 of us happen to see on the boat ride home. It's rare to see a shooting star, but for three of us to see the same one without talking about it was awesome.

Ran and worked out this morning. For the first half of today our group did a final team building ropes course. It was a great time and also very challenging. Lunch was meat in a great spicy marinate.

The final day of clinic was fun but also sad. We went to the hospital and treated just in the outpatient part of the clinic. We had mainly follow ups from yesterday. The students went right into treatment and had a great flow. First years were even practicing skills for the spine and already getting some of the key concepts down. 

We tried to emphasize teaching as this is the last time we get to work with the therapists so we tried to share a lot of knowledge. 

We are already planning to make a document and videos as tools for the therapists to have. They were so excited about the education they asked for any old books, communication, and education in the future. It felt great to know that they enjoyed what we could bring to the table and provide for them.

The goodbyes were sad but also great knowing that we will continue to leave an impact long past our stay.

Here is our view of Puerto Barrios as we made the trip back to El Faro.

When we got off the boat the team celebrated jumping into the water fully dressed in our scrubs.

Before dinner a group of 30 woman from the village came and sold handmade jewelry, bags, and artwork.

The detail of the pieces was beautiful and seeing the ladies with the work was just as great. 

Some self reflection, reading, and treatment of one of the staff members was a great finish to the day.

Ready for our travel day tomorrow 

  

Day 6. Clinic Day 4

I was able to watch the sunrise in the hammock today before another group of five did yoga on the dock. I need to make this apart of my morning routine this summer!

Breakfast was mini quiche with black beans, plantains, and tortillas. It had such a nice flavor and the sauces really added to the home cooking.

The whole group boarded the boat and had another busy morning in Livingston. The groups of 4 split off and started treating right when we put our bags down. Four patients were already waiting for us when we got to the clinic. The two groups I worked with did a fantastic job today. They were able to make even larger gains with each follow up patient and did a great job educating Ronnie, the clinic physiotherapist, on the new techniques. They also planned how they were going to make videos and handouts of the skills for Ronnie.

I was most impressed with how well they educated the patients on follow through once we were gone, home program review, and instilling confidence in each patient. This is a skill that is hard to learn and they have blown me away.

Another group worked very hard on adapting a pair of AFOs that were donated for one of the students. They worked so hard modifying and making them perfect. In the end she had a perfect fit, a new pair of shoes, and a much improved gait pattern. 

One patient that stuck out the most for me today was an elderly lady who was 2 years post a stroke that affected the left side of her body. She was only able to extend her elbow to just past 80 degrees with pain. After some manual therapy and muscle activation using cues and patterning she was able to extend 65 more degrees with no pain. She was the last patient and we only had 20 minutes before we had to leave. The group did a great job not rushing and working on her largest impairments and making a huge impact. 

After scarfing down PB and J sandwiches we got back on the boat and made our way back to the hospital for our afternoon treatments.

I made sure to not leave until I got 2 bottles of the habanero hot sauce that I loved. 

When we arrived at the hospital we were greeted by all of the same patients from yesterday as well as more patients who heard about the group. The students were excited to work with the same patients and got right into it when we got inside. Many of the patients were doing well and the best part of the time was working with the 3 students and Ta-Ta the clinic director. The combination of treating with the students and the students taking more initiative was great. With them doing more I was able to teach the Guatemalan students and clinicians more. The more we can educate the more patients we can impact. They really enjoyed the manual therapy techniques and seemed to catch on quickly to the skills.

In the inpatient section of the hospital  my group was able to see the young boy again. He will be leaving for Guatemala City tonight at 1 am so luckily we got to see him again.

He was doing better and reported no pain since yesterday which made us really happy. He was scared about his  trip to the city so we tried to lift his spirits the whole visit. After him my group evaluated a homeless gentleman who was in for a GI infection and severe neuropathy from uncontrolled diabetes. Being homeless he does not have the medications or care to manage his disease. 

As we were heading out for the day Kim and I walked by a room and saw a patients seizing. Once he was under control we were able to assist with transferring the patient. It was a scary sight but showed the reality of how emergency situations are handled. 

After a long day we got to enjoy the company of Ta-Ta, Roonie, and the other therapists and Pollo Campero. The chicken was amazing and we had some great laughs with the therapists we have been working alongside all week.

The night boat ride was very peaceful but by the time we got home we were all ready for bed. 

Day 5 3rd day of clinic

AM run and jump in the calm water with some swimming was another great wake up call.

Breakfast and quickly off to the boat for a packed day. We were so focused on getting to the clinic that we forgot Stacy and as we were leaving she started tuning down the stairs to the dock.

After gaining our whole group we made it to Livingston and started clinic instantly. With the whole group were able to divide into four groups and luckily we had the 4 groups ready because we had a ton of patients. Between the students at the school, the patients from the week so far, and new evaluations we had over 15 patients up until lunch. Some extremely interesting cases and some great progress on the patients from earlier in the week. The lady with the wrist fracture got her first restful sleep since the injury 2 months ago, another patient with a long history of low back pain was pain free after the treatment yesterday. Not only did patient outcomes improve, but the students confidence, relationships between students and patient also shined today. 

After some quick PB and J sandwiches we boarded the bus and headed to a public hospital about an hour away in Puerto Barrios. The hospital is a government ran hospital that is completely free for patients. The staffing and equipment is outdated due to this level of funding, but luckily they have this hospital for those in need. We met the treating therapist who is a very organized, motivated, and driven. She works in an outpatient clinic in the morning and runs the outpatient clinic of the hospital in the afternoon before headed to do rounds on the impatient side of the hospital until 6pm

We were able to split among 4 rooms and treat 15 patients over a few hours. Many of the patients were presenting post car accident or trauma with severely limited motion or chronic pathology. One of the groups I was working with had a young man who was in a severe motorcycle accident. He had rods in his entire L leg. He began with 35 degrees of knee flexion but after treatment he left with over 58 degrees which the local therapist was shocked about. Not only did the students do a great job, but we were also able to teach the therapist and three student therapists the techniques and skills for future patients. The other group had a similar patient with a trauma after a car accident. She has not been progressing very well and the MD plans to do a manipulation under anesthesia if she cannot get more knee flexion in 2 weeks.  The therapist was running out of ideas and worried so we worked hard trying to get her more motion today.  We struggled, but created a plan of care that the therapist could use until her follow up appointment with the MD. Explaining the thought process and techniques was fun because not only did we get to help this patient, but hopefully also the patients who she will see in the future.

Another group was working on massage for a scar and the therapist said they were already doing that. I was happy when she said this and she explained that last years group educated her on this and she had been applying the technique ever since. Working alongside this therapist is helping to make this Thrive trip very sustainable. Next year we will have to do an inservice.

The final part of the day was working in the wards with patients. My group worked with a 14 year old boy with lung problems. Much like every other patient on the floors today that we treated, he did not have a diagnosis yet and the physicians were still working on that. (Sadly this is common here which leaves us in fear of the worst causing us to be must more hesitant with care) He was doing well with high O2 Sats and fully alert. He was in a room full of 10 grown men so he sat in his corner bed. After the examination we took in out to the hall and worked on "soccer" drills. He lit up and his smile beamed.  I talk about his smile because it was a truly infectious smile. I have never said that about someone's smile, but he really had this pure happiness about him. After finishing the session with respiratory PT and education we left the room. However this young man named Edward did not leave my mind. The local therapist said he was headed to Guatemala City for more testing because they have concern of possible TB or cancer. It tore at my heart knowing a young boy with so much room for life and this sweet innocent smile had such a long road and struggles ahead. He did not have family with him or a strong support system. He is a boy learning to be a man in the hardest of times and under extremely bad circumstances.

After the boat ride back we were able to eat dinner and reflect on the long but so rewarding day. 

Many laughs filled the outside eating area due to pure exhaustion and great conversation. 

Ready for an even busier day tomorrow!