Nicaragua UIC Medical Trip: Pre trip

I was worried when I headed to Chicago for the manual therapy fellowship that I would not be able to do any PT trips for a year.

As part of the fellowship we spend 8 hours per week in the musculoskeletal lab with the second year DPT students. 

During one of the labs I mentioned my passion and experience with the PT trips and was quickly explained about the trip over winter break the students had organized. I was excited to have an opportunity open up with a new school and new outlook on medical missions. I had done all of my trips with SU and was looking forward to getting a new perspective. 

A total of 40 students and faculty will be headed down to Nicaragua on January 1st to ring in the new year PT style. 

The students have done a great job organizing the trip, getting supplies and funds, and meeting to prepare for the trip. 

For me this is very different going from organizer to faculty with less responsibility. I am going to try to help as much as I can from my past experience but also try to learn from the students and local organizations. 

Looking forward to blogging during the trip (As long as we have WiFi)

End of the conference, weekend, and travel

Day three of the conference ended in typical Ghanian fashion.  It started a little late (almost an hour), but everyone was very enthusiastic about the changes to be made, the final presentations, and the business meeting. We left during a short portion of the business meeting to see the local markets sights and sounds. 

Not much has changed from the last time I was at the market, but that rush and mixture of smells gets you very time.  Fresh butchered meat, drying fish, peppers, and spices all mixed together

The conference ended with lunch and goodbyes to old friends and new ones.

Our group took a taxi to Bosua Beach for the Asa baako festival.

We had a great time learning the different styles of music, dance, and fun.

We also got a great recommendation for a dive restaurant with amazing food for dirt cheap.

Some of the best seafood I have had 

A beach trip is how every conference should end!

We spent the last day in Ghana in a few taxis, buses, and finally a plane.

We did have a few hours in Accra and Kai's friends told her about an art gallery exhibit.

It was located at one of the nicest hotels I have ever seen. (The reception said a normal room is $450 per night... And that's in Ghana!) I have now seen both ends of the Ghanian life 

This experience was much different from my clinical experience in 2014. Less patient care, more education, and much different accommodations. 

I am already trying to find ways to come back next year!

Day 2

Today was a great day for me.

I was welcomed by Kai, JoJo, Anna and the other therapists with a Happy Birthday.

It is different spending the day far away and without family but it has been awesome at the same time.

Today was full of presentations. I gave a 20 minute presentation on clinical reasoning and the thought process of patient care.  It was awesome to see everyone engaged and listening. I was banking on the Ghana time and guessed they would not mind if I went over on my time but halfway through I was given the 3 minute warning.  Finished a little rushed but having 3 groups of therapists come up to me after to wish to speak more about the model really made it all worth it.

Right before lunch Kai gave a very educational lecture on international

Outreach and how the Ghanaians can help develop programs in their local communities and neighboring countries that are not as advanced as Ghana.

JoJo also had many people come to her poster and educate them on her doctorate research

Went with a fork and knife lunch today and had a conversation with our group as well as Anna and Pam about politics, PT development and growth.

Right before lunch started a young PT came up to me and presented a case he was having trouble with at home.  We went through the subjective and objective information as well as the current treatment plan. We also went over some new ideas with manual and neuromuscular re-education.  I never knew that 3 chairs could work so well as a treatment table.

After lunch I gave a 1:45 lecture to the Physical Therapy assistants.

We spent time talking about the structure in America, frustrations, and ways to improve competence. We spent time talking through cases, trying to make them think big picture and more patient centered.  We did a breakout to work on early patient management which was something the group said they loved after we finished.   The session ended with education on mentorship and the benefits of using mentors. The current PTA president spoke to the group and gave his contact information to everyone.  For being a last minute session I feel it met the goals of the PT's, PTA's, the conference, and my own goals for education 

End the afternoon with a beer on the 3rd floor taking it all in.

I thought the night would end there but we had a reception for the conference. The executive committee of the Ghana physiotherapy association had a cake made for me and the whole group sang happy birthday. It was amazing!  After we had a celebration, dancing, food, and the outstanding physios were awarded certificates.  At the end Kai, JoJo, and myself were given awards for our contributions which was so nice of them.

A few of us went to a local place to talk and enjoy the rest of the night

All in all a busy but great day!!

Conference day 1

The day started much like my days in the US. I was able to get to the gym for a workout before everything started.  The gym was a challenge but I made it work. The electricity is so weak that the treadmill would randomly slow down so I had to hold one to keep from falling off. The equipment had to be over 40 years old and most of the pieces were broken

After the gym I went to breakfast and registered 

A total of about 75 PTs and 30 PTAs registered for the clinic.  They have about 350 PTs so that ratio is pretty impressive.

The opening ceremonies were fantastic. The African president of the world confederation of PT, regional medical director, and the regional minister all attended. The keynote address was done by Anna. She really did a great job expressing the importance of woman's health 

Kai (a colleague, friend, and mentor) who works at Mary Baldwin College in the DPT program gave a great lecture on PT education for community based help.  Three Ghanians finished out the morning presenting their research on woman's health, Parkinson's, and low back pain.

I was fortunate to eat some amazing fufu for lunch (cassava and plantanes mashed into a dough consistency with a red soup ,goat and fish).  It is my favorite Ghanian meal. Most white people do not like this dish it know how to eat it so I turned a lot of heads when I ate it with my white dress shirt (didn't spill a drop)

The afternoon consisted of my 2 hour breakout on child handling to promote milestone development.  The audience was very engaged and laughed at all of my jokes so I think I talked slow enough for them to understand me.  JoJo (a second year Mary Baldwin student) and Kai gave a workshop on perinatal exercises which also had great feedback from the audience.

After the conference I had some great conversation with the African president of the confederation and a therapy who owns a private practice in Accra who studied her PT in Germany ( she is half German and half Ghanian)

At night my two friends from Work the World, Joe and Frank met me at the hotel.  We had a great night talking, eating, and catching up.  I missed my Ghanian family.

Ghana 2016 Physiotherapy Conference: Arrive in Accra

After 24 hours of travel I finally made it to Accra.  The flights were ok and I got to meet a few people.  I also was able to spend time reading, working on my presentations and catching up on things after my exam.

I met a family who was headed back to Ghana for the first time in 12 years.  The ladies niece was getting married and in a Ghanaian wedding usually 300-600 people are in attendance so she was making the trip with her family 

I only spent. Few hours in Accra but was able to see some stores and walk around. I spent about 15 minutes talking about religion, life, and service with this painter.  It was a great experience and we both came away with a new perspective 

At the store we learned that you can knock off any product and just change the name.  No worries about copyrights haha

I ended the Accra experience at a private physiotherapy clinic that is ran by one of the head ladies of the physiotherapist association.  Anna has been a PT for over 30 years.  She left Ghana at 19 for Europe to learn PT and after

Working for awhile moved to Canada and started her own clinic. She spent 20+ years working and developing the woman's health programs in Canada.  In 2009 she returned to Ghana and is now teaching at the physiotherapy school and owns her own clinic.   I spent most of the 4 hour bus ride from Accra to Takoradi picking her brain about life.

We got in late and I was able to get a meal before going to bed but that was about it.

So far most of the trip has been traveling but I am excited about the conference starting tomorrow. 

Thursday in the clinic

Back to full strength with 8 and everyone was very excited.

Last night Eena explained the stomach issues to mamma the cook of where we eat and asked for some variety with the meals.

This morning we had amazing empanadas which were perfect after a morning run. It was pretty peaceful running along the beach by myself while the locals woke up and the boats returned from a night of fishing. 

We split into two groups today with Eena and her group seeing mostly PEDS.

My group started with a lady who had primarily left low back pain which has been going on for about 7 months after a fall. She stated it felt very tight and "stuck" on that side. After completing a detailed exam we ended up treated with a left Lumbo pelvic manipulation which relieved  most of her symptoms and exercises to maintain this improvement. We also sent her to a medical doctor for her elevated blood pressure.

Over the next few hours we saw a few teenagers with low back pain, reviewed and progressed the home program for a patient we saw on Monday, and the gentleman with a femur fracture returned to the clinic. He was doing much better so we progressed the exercises as we also performed soft tissue message around the incision. 

The best part of the morning was during the treatment of the final patient. The three students did a phenomenal evaluation and treatment of a young man with shoulder impingement. To see where they have come in these few days has been amazing. 

To see the patient go from 90 degrees of abduction with major pain to full abduction with minimal pain was great too!

After lunch we got a ride back to the clini in the back of a pickup

We saw a total of 13 patients before lunch and worked just as hard afterwards.

My group was able to see a family of four. We started with the daughter, next the mine and after that the grandparents. Each patient presented with different symptoms and we were able to treat and improve each of them 

We got done right on time and got to spend the rest of the night on the beach relaxing until dinner

Thursday was a great day in the clinic and a great day as a group

The blog will be taking a break for the last few days of the trip but we will keep working hard in the clinic

Day 3 in the clinic

Wish I could say we were back to full strength but another day of sickness kept us at 5 in the AM and 6 after lunch.

Everyone is on medications now so we expect to be all ready for tomorrow 

We split into two groups again in the morning and we were still able to see the same amount of patients 

My half of the group saw 5 patients with two of them being ladies in the sixth and seventh decade with back and neck pain.

We also saw a gentleman with extreme left shoulder pain with all motions and activity. It was very frustrating for all of us to treat him but finally after educating him about pain and mobility as well as performing Active assisted Range of motion laying down as well as isometrics in standing.   His Motion and pain improved post treatment which was surprising to him and very helpful for us to make sure he is compliant with his home exercises.

We worked as a group with an 8th month old who was hypotonic and progressing at about a 2 month old developmental level.  It was a great experience to work with Eena and children again.  

During our fresh pineapple break we made a new friend 

The final patients each group saw was an 80 year old couple. We saw the husband who had a stroke 2 years ago. He was in therapy until the therapist had to leave but has improved a lot. Today we progressed his exercises with retro walking, VOR training, side stepping over obstacles and right arm proprioception 

The couple did not know how to read so we had to be very artistic with our home exercise programs. They were able to understand and gave us all hugs and kisses to show how greatful they were. They supported each other throughout the experience and when they started to walk away on the beach the entire group stopped and watch how much love they shared. 

After lunch my group was able to see a young man who was in an accident with a broken femur and had an ORIF 3 weeks ago. He was told to not buy any weight on his leg but told to begin therapy this week. We were able to work on walking without weight bearing, Range of motion, And strengthening. He will be returning every day to progress and work on his exercises. 

Lyndsey, katelyn and I stopped on the way back and got to play volleyball with a few guys but it didn't last long.  It takes more skill to play with a soccer ball and a 10 foot net. 

After dinner we spent some time on the roof playing cards and preparing for the next day

 

We impacted a total of 20 lives today but really I think they each touched our lives more with their compassion, greatfulness, drive, and love for others. 

Day 2

Today was a rough day for the SUPT crew. We started with 8 therapists and ended the day with 5 due to stomach sickness

We are not sure if it was something we ate as a group, the water, or degradation but it was a challenging day.

Luckily everyone is on the mends and we should be full strength in the clinic tomorrow

We split into two groups again but mixed it up throughout the day. The students took a much bigger role in the process and did a much better job with flow and communication with interpretation.

Each group saw 6 patients before lunch and another 3-4 after.

We had a few more children and Ena was able to make a huge impact with education, exercises, and orthotics.

The group also saw a lot of patients with lumbar and cervical spine symptoms which I was able to take the lead with the care. The students were ready picking up on patterns with the evaluation and treatment using past patients withsimilar  symptoms.

One of the most enjoyable patient interactions I had today was with an 80+ year old female.  She was not sure exactly how old she was anymore, she lives alone, and had full body pain. She was not able to tell us much or function well with walking or moving but she did note how she had a lot of upper trapezius pain near her neck besides her back and knees.

Working with the students we decided to do the most supported treatment of functional exercises to tolerance, assistive device for walking and assisted motion for her lacking shoulder mobility.

We also talked about treating with empathy and in asked them to think as if you are treating your grandmother. We talked about the power of human touch and decided to do a gentle massage to her neck region.

We agreed it would not cause any long term tissue changes but hoped that this would cause her to continue to think about our interaction and do the exercises.

It is very hard to only have one or two visits for physical therapy so we are working to do everything we can to increase the chances of a long term impact and success.  

Day 1 of clinic

Sunday was a pretty relaxing day spent in a small beach/surf town 1 hour away

We got to experience the food, shops, and beach.  One dollar fresh made empanadas while sitting in the sand were phenomenal 

The group spend the last night before clinic began getting to know each other.  We have really meshed well but you could sense some anxiety about clinic beginning 

The walk to the clinic was about 15 minutes but today we took a truck to bring all of the donations

When we arrived 3 patients were already waiting outside ready for us

We quickly got unpacked, organized our supplies, and split into two groups.

Each consisting of a group leader, someone who spoke Spanish and both years of PT students

From 8 to 1:30 our group evaluated and treated 5 patients and the other group completed the same amount.

After lunch we saw another 4 patients per group until 530

We had a wide range of patients from age to diagnosis and functional level

The youngest patient seen today wa s 8 months old with slow developmental progress and hypotonic. All the way up to a 90 year old man with severe bilateral knee Osteoarthritis which has severely limited his function.

The focus for me today was to let the students get used to asking questions, struggling with the process, but also thinking critically.

They all did a great job applying what they have learned and know to really

Make an impact today.

To see first year students thinking critically and interact with a patient with confidence and poise in a new situation and different language was phenomenal.

For myself it was great to apply the residency training I received with UVA-Healthsouth. The evaluation and thought process really streamlined the treatment plan and helped me to feel confident that if I can only see a patient one time I am giving them the best care and long term plans that I possibly can.

It was very different to sit back and have more of a teaching role with the students. At first it was very hard but as the day went on I enjoyed the experience a lot. None of the students have learned about the spine so I get to treat all of these patients while still showing skills to the students 

The most rewarding patient interaction today for myself was a 34 year old male with a report of a disc compression injury two years ago. He no longer works as a fisherman or plays soccer due to his pain. His symptoms stayed very local to his back but he was very afraid to move and had severe cramps with each motion.

We spent time talking about his back and really worked on movement patterns and how positive the motions were for him.

After the talking, motor planning, joint mobilization, and exercises he left with full motions, 1/10 pain, and will be playing soccer between now and Friday when we see him again.

It is hard to see such great in session changes with an evaluation and even harder in a different culture and language so it was great to experience.

As a group we had a great reflection and sum up of the day

Excited for day 2!!!