Stilt village weekend

So when I left clinic on Thursday I was told that everyone in Physio would be on strike and not going in. I was already planning my day to be a nurse in the hospital. Late that night the senior therapist called Joe and said they will not be striking and I willl get to work my last day. 

I began the day with my favorite Erbs Palsy patient. I told the family it was going to be my last day and so they brought their other 2 children because they wanted a picture as a family with me. I thought it was awesome and felt so honored that they enjoyed the experience so much. 

(They gave me permission to use this photo.) 

The next few hours I worked with the physios to implement some of the exercises and programs we talked about at the inservice yesterday. It was really nice to see them using these new concepts.

I also got to evaluate an ankle sprain. I was able to teach the senior therapist joint mobs, cross friction message to the ATFL, and dynamic exercises. She was shocked how he came in with pain and after treating and reassessing he did not have pain anymore. She will be treating this patient during the rest of his time at the clinic so we made sure to practice techniques before he left. After the session she said she really wants to go back to school and learn more to have that kind of thought process. She also told me I need to come back and teach in Ghana!  I was so pumped that I almost planned my next trip right in that office. 

The physios used the exercise log today and also were writing objectives and assessments in the folders today. I was so happy to see the ideas being carried out!! 

In the afternoon we headed to Axim which is a coast town about 1.5 hours towards Ivory Coast. We spent the afternoon in the ocean. The hotel was very nice and the showers were luke warm so everyone was very happy about that (compared to the cold showers we have everyday at the house). We had the dinner at the resturant in the hotel and the coconut chicken was pretty amazing. 

My cast away outfit

The nice showers

Coconut chicken with jallof rice and veggies 

I woke up pretty early on Saturday morning and spent a few hours relaxing on the beach and having some time for myself to take in this entire experience. The sun came out and I felt like I was on my own little piece of paradise . As I walked along the beach a few locals were collecting firewood but beside that it was me and the sounds of the ocean. Very refreshing after so many weeks of non-stop people.

After everyone woke up we had breakfast and set out for our trip to visit the Amanzule Stilt Villlage. It was built 600 years ago and is still maintained and inhabited by 450 people. We took a 45 minute canoe ride out to the village after the Tro-Tro. It was a nice workout but crazy to think that these people need to do that trip every time they need to go anywhere. 

Once we got to the village we were given a history and tour by a few of the locals and a tour guide.

Family kitchen 

Fish traps

Classroom 

The village was very cool to visit and something that many people do not see while in Ghana. 

Small block in the road on the drive back 

Heard of cattle 

All in all it was a nice weekend before I head to the village on Sunday.

Another student, Emma (nursing student from the UK), and I will be living the next week with a family of 5 in a small village called Fasin. It is primarily a farming village of Palm, rubber, and corn about 1 hour outside of Takoradi. We will be sleeping on mattresses on the dirt floor of the families home, be without running water and electricity (so bucket showers and no lights when it gets dark outside, and no more blog posts) and very little English is spoken. We will be working at a general health clinic Mon-Fri from 8-2 and then each afternoon we will participate in different aspects of the village (preparing FuFu, making wine, seeing how the Gin is made, visiting the  market they sell the village goods, and learning more about the way of life/culture of a small village. I am so pumped for this week and can't wait to write about it when I get back!!!!

Just a recap of the beard progression...

Day 3 in Ghana

Day 28 going strong 

 

Week 4

Got a little behind with posts so I will combine Tuesday through Thursday.

Tuesday: I did an evaluation on a patient who had a severe fracture of his distal

Humerus, ulna, and radius. He was on the wards for 3 months and after one month of being there they found more fractures in his proximal humerus. He was discharged from the hospital and sent to OP PT. Without x-rays we were not comfortable with doing anything more then isometrics and PROM even though it has been 3 months. For the rest of the day I went on ward rounds to the male and female medical wards to treat patients. It was a very interesting experience. The pace and attention of the nursing staff here is much slower and less patient centered compared to the US. 

After clinic the other American and I did a workout and then I signed up to take the National boards exam in October. The house had another Famte lesson and we learned the days of the week. Here many of the people are named for the day they are born.  

My name is Kwame (many people in the clinic call me this because they like to say it more then Kyle) which means a male born on Saturday. 

Wednesday: I spent the whole day working in all areas of the clinic. I worked with my favorite Erbs Pasly patient first and then another baby later, 3 stroke patients, one deconditioned patient, the orthopedic arm fracture patient from Tuesday, and one paraplegic patient. After clinic went home and did a workout. At night an ER doctor came to the house and gave a lecture on malaria. It was very interesting but the amount of detail was almost a little to much for my attention span. 

Thursday: Today all government workers have gone on strike. The entire staff at the hospital is employed by the government. For the entire year taxes have increased for government workers and prices on fuel and goods has also increased. The people have been trying to fight this and nothing has happened so today they decided to make a stand. Luckily most of the staff came in for the wards and emergency department. The entire outpatient section of the hospital did not show up. Today I was going to do an inservice presentation for the Physio staff so the entire department showed up. However they were on strike so they wore red/black and did not see many patients. Many of our patients did not show up because they had heard the news on the TV and radio, but overall 14 people still did. I ended up seeing 7 of the patients because I wanted to help and let them continue to make their stand but also give the patients care they deserve. I am glad that the people of Ghana can come together to make their voices heard and try to keep their government in check. 

We closed early so that I could give my inservice on stroke rehabilitation (it is about 65% of the caseload), Bell's palsy, and documentation. It was planned for 30-45 minutes but with many questions, demonstrations of the exercises and concepts, and discussion it ended up lasting 1 hour 40 minutes. I was so happy how much I could teach them

And how engaged they were in the information. Overall it went so well and I really think that some more of the ideas will be implemented.  They have decided to begin using exercise logs and doing short (1 sentence) daily notes. I am also going to stay in touch and follow up to provide more information and help make changes as needed.

After the presentation the senior therapist PT Mina stood up and thanked me for my work ethic, commitment, and education during my time here. I feel that I got just as much if not more from this experience then I could give them. She ended by presenting me with a traditional Ghanian dress shirt that was handmade for me by the mom of head of the Physio department. I was so honored and in shock that all I could do was hug everyone. I feel like this experience has been amazing but never in a million years expected them to give me anything. I put it on right away and then we took pictures together. 

My new shirt and the 2 senior physios 

The group and the shirt I wore to do the inservice.

Three physios I became great friends with during my time here!

The Physio department willl be on strike tomorrow and entire staff will not be going in to work so today was my last day with everyone. It was very sad to say goodbye to these new friends. By the end of the time together we were joking around, making fun of each other, learning about each others lives, and acting like we have worked together for years. I plan to stay in touch with them on a personal level but also on a professional level to keep providing information to help with care. 

Tonight is my final house BBQ and I plan on eating a lot, dancing in my new shirt, and getting ready for a fun weekend before my village experience!!! 

Club foot clinic today

More and more opportunities keep coming up here at the hospital and I am loving it. 

So every Monday one of the physios does a club foot clinic but he has been gone for 4 weeks and just came back last Friday. The clinic is in the theatre (OR section of the hospital). During the clinic I learned about how they diagnose and categorize the types of club foot from the Physio. After a few patients the only Orrho doctor in the hospital came in to the clinic. He treats all patients but has a set time to do club foot on Mondays. He has been practicing for 26 years and was very interesting to speak with. He teaches the Ponsetti Method of club foot treatment all over Ghana. Working on a few cases with him and talking about the biomechanics and lower extremity concept was very enjoyable and pushed my thinking.

While at CHKD on my last placement I did serial casting and AFO casting and learning a lot so I felt comfortable jumping right in. There are a few differences between serial casting here at and home. Here they only use one layer of padding and we use multiple at home, here they use plaster of Paris as the cast and at home use fiberglass. I got to do one cast for a patient at the end of the day with the ortho doc.

The doc is at the clinic to do Achilles' tendon releases if he feels it is necessary for a patient. Today he did one and I got to watch and he walked me through the entire procedure. There is a huge difference in standards of sterilization here compared to home. He also did not stitch up the incision but applied gauze and wrapped it in the Ponsetti casting. I asked him about the need of stitches for healing and risk of infection or worry that the incision cannot be examined for proper healing. He stated that the babies he has worked on heal fine and quick without stitches. I was still very worried about this method.

Patient before the second casting (her mother told me to take a picture so of course I took the opportunity) 

At the end of the day I thanked the doctor for his time but also spoke to him about the young girl I saw last week with the hard boney block in elbow flexion and was left in the cast for 9 weeks. It was a very professional conversation and felt that it went very well. 

Friday and adventure weekend

Friday began with a patient I had never seen before. She had one crutch and was hopping around in the gym. I asked a physio about her and he said she broke her femur and is now partial weight bearing. She had not had any gait training so I decided to take her for the visit and see what I could do. I used the scale to help her understand how much weight she was applying when standing and transitioning with a step through gait. After we did some parallel bar training for correct mechanics with decreased WB. Having her walk and during the gait step on the scale gave her more feedback. Continued to progress and finally went back to the crutch. Three of the physios stopped their treatment and watched the session. They were shocked how quickly her gait changed and improved. After that I had two of the physios work with me to see the three exercises we would do next (steam boats with theraband with upper extremity support, ambulation tie taps on 6inch high targets (to improve functional single limb stance) and matching seated on therapy ball). Improving sit to stand while taking some weight was harder. Every time she did it incorrectly I had her restart and try again. That did the trick and by the end of the session she walked out a different lady. This was one of the most rewarding treatment sessions of my time here because the results were immediate, you could see how proud she was of herself during the session, and the physios thought I was a miracle worker but showing them the techniques made them realize how simple it would be to do with all patients. 

After helping a few other patients I did an eval on a middle aged man with neck and mid back pain. It was nice to get mechanical pain again. I walked the senior Physio through the eval process we typically do. She said she really liked how thorough it was. After providing my diagnosis and home plan she told me what she would have done but now realizes how much more sense my treatment plan made for his impairments. We worked together to determine treatment plan in the clinic and how to progress based on how he presents. ( I decided that the hypo mobility of his thoracic spine was what we would target first based on presentation and she said she would have done cervical traction because it was neck pain.)

Worked on a few more cases before leaving for our weekend adventure. We got a Tro Tro to take us to Kakum National Park. 10 of us arrived and got to watch the sun lower over the rain forest 

We then made the hike to our camp site and a couple hours later set off on a 2 hour night hike through the forest looking for animals and learning about the vegetation, wildlife, and history of the forest. I spotted a bush baby high up in the trees and we saw some other animals but not clear enough to make out. 

After an interesting night sleep Samuel, our tour guide, woke us up at 530 to watch the monkeys jumping in the trees. We couldn't make any details of the monkeys, just shapes, but still awesome!! At 6 we set out on the canopy walk. 7 rope walkways attached to the tallest trees made up the 120 foot high adventure around the forest. It was a nice adrenaline rush to wake you up

Scrubs tucked into the pants because the ants were awful and had a solid bite. 

The pictures don't even do the rain forest justice. It was so beautiful and the sounds of the animals and insects were so relaxing. The shaking of the bridge with every step kept us from relaxing to much. 

We left the national park and headed to a monkey sanctuary. 10 years ago a Dutch couple came to Ghana and opened a place to help raise baby monkeys who's mothers were killed by hunters in the area. They now have monkeys, snakes, mongoose, Dinka, and large animals from the cat family (the one that makes the most expensive type of coffee bean from the movie The Bucket List)

We drove a little further and stopped at the crocodile cottage for a late breakfast. They rescue and raise crocodiles (another Dutch couple). For 1 Ghana cedi (33 cents) you can touch one of them.......

Auntie Mary trying to turn the crocodile around .....

.... Had to one up it.....

And when he was done being around us he got up on his own and left

Before noon I would say it was quite an adventure!!!!!!!!

We got back into our Tro Tro and continued to Cape Coast. When we arrived we got a tour of the Cape Coast Castle which was used by the British for protection and storing slaves during the slave trade. It was crazy to be seeing the other side of this history that we learn so much about in school. It really hit hard to see the dungeons and how the slaves were taken from their villages. Being inside the rooms, smelling the smells, and hearing the stories gave me chills. The museum in the castle was very interesting and had great information. They had a section about the influential Africans in America during and after slavery. It was nice to see that the people of Ghana are still able to see the positives of such a terrible part of their history. 

It was a beautiful and well preserved castle....

We had a nice dinner and music at a local hotel on the beach. A bunch of Europeans and Americans were there and we had a blast meeting other people and learning about why they were in Ghana. 

We got back from the trip early on Sunday and all had to do some hand clothes washing after the busy weekend. 

3 students left on Saturday and we are getting 5 new ones today. The only other guy in the house is going on his village experience this week so I will be the only guy in the house for a week..... This will be interesting 

Village outreach

Today we went to a small village about 1.5 hours from Takoradi further west towards Ivory Coast. When we arrived there were tons of children in school uniforms to greet us and a long line of adults ready for the clinic. 

We had 4 tables set up to do blood pressure readings, blood glucose screenings and hepatitis B screenings. In total the group screened between 250 and 300 people over a 4 hour span. A group of medical students addressed other illnesses and helped to provide advice for patients. A few children had some wounds that were not being treated correctly or not being treated at all. A few of the nurses and I cleaned and dressed the wounds.

Overall this was a great clinical experience. It reminded me a lot of the SU medical mission trip to Nicaragua with the set up and flow of patients. It felt very nice to work in a more remote setting where care doesn't not usually come as often. I also liked doing screens that I would not normally do as a PT. 

Our group finished the clinic and then walked a few hundred feet to the beach to have lunch, relax, and then had an intense game of sand soccer to finish of the day.

Working on a few items for clinic tomorrow and then hanging out with the housemates before our big adventure in the forest this weekend. 

Best part of the day..... Our bus driver had a Ravens hat hung up next to him. I have him a big hug and told him how proud I was of him (he had no idea who the Ravens were but I did not care). I also made him put it on so I could snap a picture......