Clinic began with another student who has learned how to practice but has created shortcuts and fell into the system of treatment. He made many assumptions about the patient, used the script as his primary clinical reasoning, and did not try to dive deeper into the patient during the subjective. With guidance he created strong differentials and had a much better understanding of the patients pathology. The patient was a young man with a knee injury from a motorbike accident. His injury was in December and did not start PT until today which shows how slow the system can be here in Kenya. He learned how to better use the objective measures to drive treatment and how to treat more functionally with exercises of a younger, higher level patient. The patient reported with a better confidence with movement and what he needed to do for strengthening. Andrew, the student, learned about how to determine duration and frequency of treatment today. He wanted to see the patient 2x a week only because that is what he always does. However the patient drove 800 km and had to stay overnight for just one visit. After some explanation he was able to understand why the patient should only come every few weeks with an emphasis on HEP and self management.
The second student came late so I worked with one of the stronger OMT therapists at the hospital and Kala, one of the SU students, on a foot/ankle case. The focus was on using impairments vs pain to drive treatment. The patient had a fusion of the mid foot due to severe foot pain and deformity. His biggest limitation found during the exam was gastrocnemius/soleus weakness and hypomobility and limited dorsiflexion of the 1st metatarsal phalangeal joint. It was a great experience to use gait analysis, manual assessment, and questioning to challenge the thinking of both the advanced clinician and student at the same time. I really enjoyed this time with them.
After that I had a few minutes so I walked around the clinic and found Tony in the Pediatrics room with Juliet. They were working with a one year old patient post meningitis. Her developmental level was about the level of a 3 month old. I enjoy this age and really enjoyed joining in with this case. I was able to use some of my past experience to help provide some ideas and also learn some treatment strategies from both Tony and Juliet. This made me realize how much I miss treating the pediatric population.
Before lunch the second student finally arrived (1 hour late but apparently within the Kenyan understood late time). Her patient was one who was seen by a newer therapist 8 times before this visit. Emphasis today was determining current effects of treatment, reassessing all impairments, and determining the plan of care going forward. She had some trouble with the subjective like many of the other students and needed guidance during most of the objective aspect and intervention. After the session I learned that she is in the residency program for orthopedics, but her job is inpatient on the wards. So sadly she does not get to practice or implement much of her coursework or mentoring into practice during this year. Erastus, one of the lead teachers in the residency, explained that many of the employers due to not understand the residency and how each student should be working in orthopedics to work on the skills they are learning. Hopefully as the program continues, the employers will see the value and make adjustments to their thinking.
After clinic, Emily Tony and I went on a run and did a workout because of the nice weather. After that we were given the opportunity to watch the local club rugby team. We got to meet some of the players, talk to the physiotherapist, and enjoy the practice. It was a great experience for me to learn more about rugby and compare/contrast the sport to American football.
After practice we went to a local rooftop to listen to a local band. We had a great time as a group tonight!
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