Clinic Day 1

Today was a great first day in the clinic. We began with a great meal prepared by our host mom and set off to meet as a group. We planned to have 4 house visit evaluations that quickly turned into 6 when our translator explained that another two patients had asked for therapy in the area we would be treating.

The three students I was working with did a fantastic job working together during the first evaluation.  For some of them this was the first patient they have treated. Doing this is stressful enough, but add a foreign country in a language you don't speak makes it even more of a challenge. The first patient was a young man who had polio and severe scoliosis. We did not know what to expect but we all were excited when he was doing everything without an assistive device. The students did a great job working to perform a subjective and objective evaluation finding key information and looking at functional movements and patterns for treatment. They also took photos and videos as baseline measurements for objective measures. The patient was highly

Motivated as he already does 4 exercises daily which includes 50 repetitions of each workout!  We finished with a detailed explanation of his home program an de our plan for the week.

The second patient was a young girl who was the first born of twins. She was one of the patients added on to our schedule so we only knew that she was undiagnosed. When we entered the house I decide to take the lead having had PEDS experience and missing working with kiddos. It was so much fun getting back on the floor and assessing young children.  It was quickly evident that she had a severe disability. After the evaluation I found her developmental age to be about 4-5 months when sadly her biological age was 2 years old. She was very far behind her sister and was unable to sit unsupported or hold her head up in prone for more then 3 seconds independently. Today, my emphasis was education to the mother about tummy time and working on molding and hands to feet playing. Very fundamental things that she had not been doing. The aunt was able to perform the exercises and before we left we asked if she had any more questions. The mom asked if she would be able to walk soon.  The students were shocked by this question... as we just saw how far behind she was and that she could not even sit unsupported.  We answered the question by saying how she needs to master these skills and as she progresses with her strength she can continue to work toward walking. We cannot guarantee that she will walk, but we did not want to give false hope that crush dreams by making a definitive answer. We wanted to focus on the short term goals for now.  Education will be huge with this family!

The next patient was a 93 year old man who was wheelchair bound after a fall last year. He broke his hip and was unable to have surgery (the patient said his doctor told him it was due to medical issues). The students worked on a fantastic history as I looked at the x-rays his daughter provided. The x-ray was one of the worst hip fractures I had seen. The femural head was still in place but the femur fractured at the surgical neck. The bone went upward and was in line with the iliac crest. In sitting his femur was about 4-5 inches shorter on the left compared to right. He was non weight bearing and either sat Orndorff laid down all day. Our treatment and exam quickly went away from hips to working on pressure relief, transfers with the family, and positioning. This was a very interesting case and a great experience for the students. 

One of the other newly added evaluations was his other daughter who also fell and broke her hip. Luckily she was able to have surgery so we decided to focus on the older gentleman and would evaluate her the next day.

The 5th patient was an elderly female who was bedbound and relied on her family for everything. When we tried to evaluate her she was getting changed so they told us to return tomorrow. 

The final patient of the day was a stoic male with Parkinson's. He lived with a large family and those dynamics made the evaluation hard. When the students performed the evaluation the family wanted to answer many of the questions and tell the patient what they believed. They did a great job of taking control and making sure that they got the information they needed and built a bond with the patient. He was very sedentary and believed that Parkinson's caused his pain.  We had to spend time educating him about what Parkinson's is, and the effects of lack of activity on joints and pain. He seemed interested in the treatment plan for the week including music and movement. 

We had lunch back at the house and then spent the afternoon traveling by boat to see the small islands of Nicaragua created by the volcano years ago. They have 300+ islands off Nicaragua. We got to see a few including the "monkey island" with moneys living on the island and hanging out on one that had a reaturaunt and pool. At the end of the fun we sat in a group and did a fantastic reflection. The students had some great ideas and really learned a ton about themselves, the culture, and clinic which was great to see in only one day!

After a meal back at home we ended the day at a local hangout spot reflecting on the experience.

Excited for clinic tomorrow 

Getting started

New Year's Day was a long day of travel.  Rung in the New Years with Olivia and her family on FaceTime and then went to bed ready for the day. After two flight delays I finally
made it down to Managua. The other flights of the group also had some minor delays but we all made it down that night.
We packed in 2 vans and got dropped off at our homes for the week.  We were placed with host families in either groups of 2, 3, or 4.  The houses in Granada are so beautiful and the roads are fantastic. This is a very nice town and lucky to stay in such a great area.

After a short sleep we spent Monday meeting with the organization leaders touring the town we are staying in and the area where we will be treating. After that the students were split into groups and meet with their translator to learn about the patients and ask any questions. Our faculty group worked to divide ourselves and try to maximize our help.
We are doing the care in homes which makes it a little harder to divide ourselves. We have a game plan that involves running around (which I like, but most likely will be hard to do ) which may change after tomorrow.

We headed back to our homes for lunch and then had 2 hours to get ready for the afternoon. After unpacking and meeting the neighbors host families I did a little push-up workout at had a great conversation with the host father about working out, language, and ourselves. My Spanish is terrible, but with a lot of charades I felt the conversation went well.  

The group split in two for the afternoon with 1/5 of the group teaching children yoga and the rest of us playing soccer with some more children.  It was a great time and showed just how good they are at soccer. I even got to do a little first aid on a translator after he ran into a pole and cut his eye open! He is doing great, but glad I got to get some healthcare in today.

Authentic beans and rice filled our plates for dinner and then we all met up to discuss treatment plans and watch some of the Rose Bowl.

We are all ready to start treating tomorrow!!

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.