Filipino Birthday Gymboree

Assisting with wound care

We awoke to a beautiful sun-shining morning.  Upon driving to the hospital, the skies were so clear we could see St. Vincent in the Caribbean distance (the island south of us).  At the clinic we spent most of the morning observing and assisting with wound care.  

 Then the students and Fehrn left to go visit children at the local special needs school as requested by our Peace Corp neighbor Toni.  Steph was in seventh heaven due to her recent completion of a pediatric internship.  It was a nice birthday present for a potentially future pediatric PT.  Our first patient was a severe extensor tone to the point where her head could touch her feet, as if she was doing a backbend.  She was 9 years old but her physique appeared only 4-5 years old.  We were able to do education of positioning and techniques to temporarily relieve the intensity of her tone.  Unfortunately, at this time, there was not any posturing devices or bracing that is available to achieve better posture throughout the day.  The other child that we saw was a 7 year old boy who had his left foot turned in at a 90 degree angle.  He did have a foot brace that was not helping but we concluded that the deformities were due to the laxity in his knee ligaments.  We were hoping to supply him with bracing to achieve a normal gait and to run with his peers again. 

Birthday Girl!

Upon returning to the hospital, Steph, Frances, and Barb treated the remaining few patients and Becca took an adventure to find a car for the weekend.  After clinic hours, we headed straight to a small fishing town nearby called Laborie, where we explored a few local craft shops then headed down to a picturesque little beach for a little R and R.  However, it turned into an hour long photo session, where we got some freaking awesome shots.  Palm trees, yoga, gymnastics gymboree. Unfortunately, Frances kicked the birthday girl right in her hand, which resulted in a bruised scaphoid (bone in the hand) and thenar eminence (big fatty part by the thumb).  

Yoga Blitz

Becca found some new legs!

 

 

Filipino birthday dinner!

Upon arrival to our apt. Steph had a big surprise waiting for her.  We had arranged for a home cooked Filipino meal, which was to die for.  The master chef was none other than Thomas, one of the PT’s we have been working with in the clinic.  We also had a scrumptious traditional Caribbean cake with matches for candles.  We had a total of 8 people in the house filled with lively and fun conversation for the evening.  Tomorrow we are planning a fun-filled day of adventures to the northern part of the island.  

 Insert from Steph:

 My friends are absolutely amazing! As usual, I was completely oblivious to everything going on around me and Fran, Becca, Barb, and Thomas planned a wonderful birthday dinner!! I think I can speak for all of us when I say, "Thomas is such a great cook!" We were all eating even after we were full it was so good! Lucille, a woman that works in pharmacy, made a great cake too....that was decorated with 25 matches!! Don't worry, we only lit three! I am so lucky to be down here for two weeks and to celebrate my birthday with such wonderful people! Thanks everyone :)

Heidi and Ardene: I went to a school today (totally in my realm)...we need to get some people down here! They were telling me how much they would love to have therapists to come into the schools to help the children. The children are so cute and always waving and saying hi!

Serenity in Paradise

Breast Cancer Awareness Scrubs

“God grant me the serenity
to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference” (Serenity Prayer, Reinhold Niebuhr).

Each day we see many patients and think, if they were in US, things might be a little better--like a patient with diabetes and an amputation who can’t get a prosthesis.  We cannot change that and must accept that…





Working in a developing nation, like St. Lucia, is eye-opening.  We marvel over the changes that have been made here.  Like the fact that, St. Jude Hospital burned down 2-years ago and today, they are fully functioning in a sports stadium!  Wild!  They amazingly merge many local staff with supplements of volunteers like Dr. Lisa Fletcher who has been coming here for over 10 years for 12 weeks per year.  And, there is Ferhn Henry, the director of the PT department, who has ambitious goals and strives to make improvements in the lives of her patients and in the services provided by her department.  It is a remarkable place!

People think we as PTs help others but truly, our patients give us so much more.   

 

Today was another great day!  We have clean laundry!  Unfortunately, Barb’s big bath sheet now resembles a hand towel and Becca and Steph’s clothes have bleach marks but we are thrilled to have clean clothes!  

Using his daughter's cell phone to capture his home exercise program

We saw many patients with diagnoses we seldom see in US!  Steph had a 13-year old boy with severe genu varum (bowlegged) due to Blount’s disease (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002551/).  Steph made a home visit to see a patient with paraplegia from a cervical spinal cord injury, who spends his days in bed with multiple pressure ulcers. Frances and Becca both were involved in wound care several times throughout the day. It was slightly scary to see what a mosquito bite gone wrong can look like, haha!  They also handled treating and evaluating patients while Barb was providing an in-service for the regular PT staff.  Barb had a patient who had multiple trauma injuries resulting in generalized weakness of his leg coupled with an uncorrected leg length discrepancy.  It was cool to have this man’s 16 year-old daughter take pictures of her dad on her phone so she could help him with the exercises!  We found another use for Carole Bernstein-Lewis’ textbook!  Just wrap the book in Theraband and use it as a lift on his shoe!  We are in awe of how technology can be integrated in rehab in this developing nation yet, there is a paucity of prosthetic and orthotic devices.

Using a textbook to increase leg length

In closing, Barb would like to share one of her favorite quotes from Albert Schweitzer (2009).   “I don’t know what your destiny will be, but one thing I know: the only ones among you who will be really happy are those who will have sought and found how to serve.”   We hope you find the happiness we are found through our patients and colleagues in paradise!  Blessings to you and yours!

Bloggingly yours,

Barb, Becca, Birthday Babe Steph, and Frances

Butterflies, Bugs, & Buses

We had matching butterfly scrubs! :-)

"I love you," said a patient to Frances in the ward today after teaching her how to walk with a walker! We are in aw of the gratitude expressed to us, by 99% of the patients. 

The skills demonstrated by the staff in performing every activity from podiatry to brachial plexus injuries is inspiring, due to relative limitations and resources. A sock and a cast boot for a pediatric patient (donated) became a stump shrinker and prosthesis for a patient with a foot amputation. It is also wonderful to see the staff so engaged in Barb's educational presentations. Although Barb wasn't sure if she should cover multiple sclerosis since its prevalence is 1/100,000, we treated a patient with MS today.

Patient Education on Steph's iPad

There is an IT department that works out of a trailer next to the stadium. A young man learned his trade via the Internet and trial and error and has been able to connect the hospital to wireless Internet. He is getting ready to set up the IT "things" for the hospital that is being built. Due to his knowledge and graciousness, we were able to connect our devises to the hospital's server. This technology has helped us better serve our patients. Steph and Barb were seeing the woman with MS and she told them that her son has access to Internet. It was great to be able to show her the website for the national MS foundation so she could understand how to navigate the website and learn about the disease process.  

Debridement of a venous insufficiency ulcer

Wound care is very common in this setting and we are impressed with the skills and sanitation
measures taken by the physical therapists. As students, it has been a real privilege to be exposed to such a specialized aspect of our profession. 

Next up on night time adventures...

Becca, Barb and Steph went out for a walk...and guess what?!...it began to rain...again. So, to keep Becca's  leg from rusting...again, her and Steph made a run for it home, only being slightly soaked by the time we made it there. It was a fun time! 

We were all missing contact from people back home so we had a mini Skype night with friends back in the States, which ended up being a mini class of 2013 reunion! It was so nice to hear from them; as much as we are enjoying our time down here, we miss home!

Dinner was delicious! To get back to our apartment from the hospital, we take a minibus from the hospital to Vieux Fort, walk a block, and then take another bus to 'O.J.' (Old St. Jude hospital). The first stop is near a supermarket, so we quickly stopped in for a few odds and ends. Barb made pasta, carrots and green beans! 

Fran murdered the 52nd bug

We have found that Clearasil works wonders on bug bites! So does smashing the bug before it sucks too much blood!  We currently between 51...oh wait 52 bug bites between the four of us.

Well that concludes out sixth day on the island...until to,or row, happy reading and have a great night!

Washing Down a Squeaky Toy With Bread & Water

A view of the whole stadium.  Both sides are used to the max.

Today’s patient case load was just as diverse as yesterdays and went much smoother now that we’ve learned the ropes.  Upon arriving at the clinic this morning we each got our own patients to either evaluate or continue previous treatment.  Later in the morning Barb and Becca went into the ward to help those patients sooner since the manpower was available to allow time for clinician education in the afternoon.  

We have found there are a number of patients that come from the north end of the island (i.e.-Castries), which means over an hour drive just to come to PT.  This gives us an extra awareness that we need to be making the best use of the patients time, as with every patient to make us better clinicians.  Steph worked with a patient who informed us of some great places to eat when we venture up to Castries this weekend and he would like to meet up with us to show us some of his area.  Becca had an opportunity to work with an amputee.  She was an elderly woman that received a lot of motivation from sharing in Becca’s experience.  She walked farther than she ever had today, even though she didn’t believe she could do it when the session began. 

At lunch we were talking to one of the doctors of internal medicine here at the hospital and had a very nice conversation.  He mentioned that he has “never met a physical therapist that wasn’t passionate about their profession.”  We were very encouraged by this statement as we greatly desire to see people improve their quality of life due better movement.  Our satisfaction is found in seeing patients get back to doing what they love.  

Clinician Education

Since the extra hands allowed for all the patients to be seen a little early, we had an hour of clinician education at the end of the day.  Barb educated about neuroplasticity, especially as it relates to recovery from a stroke.  In simple terms this means the ability of the brain to make changes that allow for increased function when treated in certain time frames.   

Buying Bread

Upon arriving back to our apartment, our evening adventures soon began.  Barb went for a walk and stumbled across the bread delivery man that we always hear go by in the morning selling bread.  She came rushing in exclaiming to grab our money and a plastic bag because the bread man was coming.  The bread that a local Peace Corp worker gave to us last night got us hooked!  When the bread delivery man comes they drive up and down every street beeping their horn so you hear them and are ready.  If you are not standing outside your house, he goes flying by so rushing out is important.  We got an entire bag full of local bread and dessert breads for about US$2.50 and boy were they delicious!! Water here can either be store bought or boiled for 10 minutes before it is drinkable.  Us students are all about saving money, so Becca spent 3 hours boiling enough water for the next few days.  The freezer is no longer cold due to so much hot water being placed in it to cool. Whoops.  Good thing ice cream is expensive here and we don’t have any.  This evening  ended similar to how last night ended.  Some animal began making this very strange noise that sounded very similar to a rooster choking on a squeaky toy.  But we must say, we wouldn’t complain too much if this were the case because he began crowing at 11:40 last night.  We all ended up sleeping on the couches in the living room due to a certain jumping lizard incident (reference to Parent Trap for you fellow children of the 90’s).  

 So to end the night…

A man goes to the PT and says to the PT:
"It hurts when I press here" (pressing his side)
"And when I press here" (pressing the other side)
"And here" (his leg)
"And here, here and here" (his other leg, and both arms)
So the PT examined him all over and finally discovered what was wrong... "You've got a broken finger!”

Stadium Treatments and Salty Butter

Day 1 at St. Jude Hospital! Dr. Jeff O'Brien picked us up at 7:30 am for our adventure. The hospital is gracious enough to give us free breakfast and lunch...even dinner if we want to stay later! Mr. George Lee met us at breakfast and then we began our tour of the hospital, which is a stadium that has the indoor sections converted into rooms. It has an emergency room, operating rooms, administrative offices, etc. The rooms are just like we see at stadiums back home with the beds sectioned off by wood. The previous hospital was burnt down by a devastating fire. Despite being an undeveloped country, they have made tremendous utilization of the space and materials that they have. We were blown away at how efficient the hospital ran with the challenges of operating out of a stadium and not having a facility.


We met MANY of the staff of the hospital, all whom were very nice and very appreciative of our services. One gentleman informed Becca that her name was very common in Patois and means "salty butter" hahaha! The phsyiotherapists work in the outpatient room from 8:00am-2:00pm (ish) and then spend the last two hours in the hospital ward (other side of the stadium). Around 8:30 we made it to the "physiotherapy" room where we immediately began our first evaluation. Being the first patient, the three students worked together. The patient was referred for a diagnosis dealing with the sacroiliac joint, but we concluded that the pain was secondary to weak glut (butt) muscles and poor body mechanics when lifting...yay for looking at the whole picture and not just the diagnosis (thanks Dr. Shipe)!

 After that evaluation, all of us were split up and treating patients independently! We are lucky that we graduate PT school as generalists, as it is going to be very beneficial at this hospital! This is day one and we have seen sickle cell anemia, rotator cuff injury, 7 y.o. male with a burn, previous cervical spine surgery, shoulder impingement, cervical strain, rheumatoid arthritis of hands, back strain, stroke, tibia-fibular fracture and traumatic brain injury via motor vehicle accident, ulcers, Syme's amputation secondary to type II diabetes, and chronic regional pain syndrome. Yea, we are going to get some great experience here!

Lunch was amazing! We had some chicken, rice, pinto beans, lettuce, potatoes and a delicious bread pudding cake. Fran and Steph ate lunch together and met the hospital director, named "Francois" whom, "will never forget Frances' name!" He was absolutely certain that we younger than twenty when we told him we were 25 (well almost, Steph is 25 on Friday!!). We stated, "We appear younger because we were in the sulphur springs yesterday." Francois got a big kick out of that one!!!

We used public transportation for the first time as well! We took the "bus" (van) to the supermarket after work to do some shopping so we can cook dinners throughout the week. Dr. O'Brien also had to do some shopping, so he was nice enough to give us a ride home!

Barb made a delicious pasta with olive oil, broccoli, garlic, onion and some yummy cheese. She also made a side of okras, which we have never had before. We must say, they were pretty good despite not having enough spices, according to Barb! Meanwhile, Steph was attempting to brew a cup of coffee without a coffee pot. It took 30 minutes or so, but she was able to get a full cup! (Note this was her first cup of coffee and first drink with caffeine in it for the day...impressive!)


After dinner, we went to take Dr. O'Brien a plate of our yummy dinner, but ran into Dillon (the IT person from the hospital) who just picked up his brother, Wyclef. Wyclef was hungry so we gave the plate to him.  We then made another plate up and took it to Dr. O'Brien.

We don't know what our adventures hold tomorrow, but are eager to continue to help the staff at St. Jude!