And another great day in clinic

I began the day treating one of my usual babies with Erbs Palsy. He is so much fun and I have a great time talking with his parents about Ghana, places I've been in Ghana and learning about the places we will be going on the weekends. The people always want to give advice and help you to learn about their country. I love this aspect of the culture here! 

I did an evaluation on a young boy who got a malaria injection 2 weeks ago which instantly resulted in a nerve palsy. The dorsiflexors and everters of the right foot were 1/5 with muscle testing. The senior Physio explained that in school they learn where shots should be administered and have been seeing that nurses are being lazy or negligent and putting it in the incorrect location of the butt hitting nerves. She has seen these cases more often recently and is very frustrated by it. 

I also got to treat my first Bells Pasly patient ever. I have not been able to treat anyone at home with this condition they have many cases here. The senior therapist had Bell's palsy when she was younger so she got interested in this diagnosis and has made it her "specialty". She showed me the treatment she uses and let me work on one of the patients. She uses baby power as the medium for the message and says she likes it more then message oils or cream. I really enjoyed learning these new treatment techniques and hope to apply them when I return home. 

The young girl from the other day with the cast that was left on for 9 weeks returned today. Her mom got an X ray and after looking at it we could see a bone that should not be in the joint which is most likely causing the early end feel. However no report was included. She had to leave the clinic and find the only radiologist in town to get that done.(sometimes the flow and structure of medicine can be so frustrating and run patients in circles). After 3 hours she returned and the report stated a mal-union. I wrote up a report for the patient to bring back to the orthopedist. The senior therapist said that she doubts anything will be done and will most likely need to send her to another private hospital outside of West Ghana. This lack of motion is not allowing her to eat or wash her hair with her right hand (here they eat with their fingers and it is considered rude to do anything with your left hand because that hand is used for the bathroom). She will have many issues if something is not done for her. I plan to keep working on this case while I'm here and press the therapists to keep on it as well (I sense their concern when we talk so have a feeling this will not be an issue). 

Ended the day having a sit down one-on-one with the head therapist regarding my clinical evaluation. It went very well and had lots of feedback for each other, my teaching, the clinic, and the next week and a half. 

Did Insanity in the rain with the other American and then had our weekly BBQ with the house. Amazing food again and rocking the new threads! 

Week 3 day 2

Today in clinic I tried to be even more independent and start to get patients going on my own. I worked with two children first who had CP. They both did not cry once which was amazing and better then last week. One of the children was able to sit in kneeling without assistance by the end of the session which is something her mom said she was never able to do. 

Every patient has blood pressure assessed before the session. Today one person had 160/108 and the therapist asked if he had taken his meds or had food. He told the patient to go eat and come back in an hour to try again. I was shocked that the patient got right up and left. I could not see that working at home but here the patients will do what they are told so they can be seen. 

Next was an evaluation for a patient with the diagnosis of Wernicke's Encephalopathy. I had never seen a case like this so I grabbed another physios phone and did a 5 min search and then did the eval. It was a very interesting case  with a history of alcoholism (often seen with the diagnosis) drinking poorly manufactured Ghana Gin. Biggest impairments were vision, balance, gait, and strength. After the eval

I provided him some intervention and a home plan. After the patient left, the senior therapist who was observing me stated how she had never heard of this diagnosis and would have never looked at vision/vestibular because of her lack of training. I will be doing some research tonight for the therapist on the tests and exercise that can be used for patients with these impairments.  She also stated she would love to do a case study on this patient! 

Had another patient who was a re-eval that had a femur fracture and just got cleared for weight bearing as tolerated on the right. Using a scale (one you stand one to measure your weight) I was able to get him to undertand how to put weight down and use a normal gait pattern. Every other way I tried to teach it did not work. After the session he told the senior therapist he would not pay for the session today because he worked to hard during the re-eval and not in the gym where he normally goes. He also said in Fante that the white guy did it all and not them. That made me a little mad because I am working along side the staff and just because I am white should not mean that I do not work for the hospital. 

Got to sing Da Nase (Fante song we learned) at clinic today and everyone laughed but then joined in. It was really fun. I love how happy people are and how much music and song motivates these people. Even when it is crazy busy in the clinic you don't see people complain. They sit patiently and wait or help another patient with their therapy. 

Did a workout in the afternoon and then did my laundry the old fashion way with two buckets, water, and some elbow grease.

I also went to the seamstress to pick up something I had made. Look forward to wearing it at the BBQ on Thursday.... And every day after that too.  It's a pretty sick shirt!!

Tonight is our second Fante lesson at the house.

Beginning of third week

Spent the morning at clinic today in the electro therapy part of the clinic. They used estim, microwave diathermy, infrared, heat packs and cold packs.  They really believe in the use of machines to help with the pain, increase in blood circulation, and healing.  Some of the equipment is not used much at home anymore so it was very interesting to see how it was used.

After a couple hours I began to do Evals. I evaluated a lady after a wrist fracture who was sent a month late to PT because the doctor was on leave. The next was a young girl who had a distal humerus fracture who was left in her cast for 9 weeks because that same doctor was on leave. It's sad to see patient care lost because a doctor leaves. You would think that they would have someone cover or find ways to avoid gaps in patient management.

Also got to see a patient direct access after a MVA who needed to be sent for X rays again before treatment will begin. Finally I got to work with a patient who has been a paraplegic for 7 years and wanting to begin therapy again. He has not had Physio for 2 years and his planter flexion contractures reflect that very much. Hoping that he will see a medical doctor to determine what can be done to help correct this problem.

Went to the small orphanage again today and had a blast playing soccer with the kids, throwing them around, and meeting the volunteers who are staying at the orphanage. 

Sunset on the ride back from the orphanage 

Second weekend

This weekend was the funeral so we had to leave on Friday early to make the 6 hour bus ride. Almost everyone was in the bus and the driver decided that he needed to adjust the park job which resulted in him loosing control down the hill and crashing into the ditch. I always wait until last to get in to make sure we have everyone and that everything is ok, so watching this was pretty crazy.  Luckily everyone was ok and a few of us had to help push the van out back onto the road. We had to wait for another driver but an hour later we were finally on the road. 

1.5 hours into the ride we saw a group of children on the ride of the road and a few cars around.  Apparently a taxi driver going the other way was being reckless trying to pass someone and ran a bus full of school children off the road. We got out to help and tried to use the first aid we could to banage up wounds and I helped to get some of the kids into the taxi. It was pretty shocking how many people stopped to help and taxis that just grabbed kids, bleeding and all to take to the hospital. The driver and two children were in pretty bad shape and rushed first. Everyone was taken away before the police could arrive.  The rest of the trip was less happy and made me really appreciate the fast responses by medical personnel at home

And strict rules of the road.  It was really great to see how many people stopped to help and assist during the time of need. 

We arrived in Kamasi and had a meal. I got to try Fufu which in a vet traditional dish. After half of us went to an old fort converted into a war museum and learned a lot about the independence, military, wars, and African history.  A group of school children were also doing the tour and after wanted to take pictures with the brunies. We felt like we were part of the tour! 

We went back to the hotel to find out that  there wasn't enough water pressure to take a shower so we had to bucket shower. I got to practice for my village week coming up. 

The next day we went to the funeral. It was a very interesting experience as we were the only white people (300-400 people total) in attendance. We had traditional outfits made of the event so we looked like everyone but still turned heads. I sat back the whole time trying to see the customs, traditions, and workings of a funeral ceremony. It lasted about 2 hours and then the group went to the cemetary and we had to go check out of the hotel.  Biggest differences I noticed during the ceremony were:

1. He died 1 month ago. They normally wait to have the burial until later and when the family is ready

2. Everyone goes! He was 77 and people from all over attended showing the family support. Very close knit communities.

3. The ceremony is very family, church, career, and club oriented. They had a speaker from each aspect of his life 

4. The funeral process lasts 3 entire days.  It began Friday, was 4 am to 8 pm sat and then Sunday. 

We headed back to takoradi on Saturday afternoon and arrived after dinner. Spent the night hanging out with people in the house.

Sunday am I went on another run around town and took a few pictures:

A lot of people were at church so the roads were not very busy. 

On the final hill back to our house a few children were outside playing and wanted to run with me. We did a few hills and after started to play with them and hangout. They wanted a picture before I headed inside:

Went to a hotel for the afternoon with the group to relax and go in the beach. Even got a little studying in:

At night we went out to dinner for one of the girls birthday. I spent the entire time watching the World Cup final with the other guy from the house.

HIV clinic day

Today 3 of us went to the HIV clinic today. We spent the morning in the pharmacy learning about the drug combinations, how they dose, and how the structure in the clinic works. We followed a pharmacist around and watched the interactions with patients. Next we went to the consultation room and spoke with a nurse about the basics of HIV and the stigma in Ghana. Also got to watch some of the interactions with patients.  We spent a few hours in the afternoon with the head doctor who is also the regional director of HIV, leading researcher, and Ghana head for STIs. We went to speak with the nutrionist and had all of our questions answered.

It was a really cool experience and not something I would normally get to do on rotation at home. 

Spent the afternoon doing a workout and relaxing until the BBQ with the house.  Had great food and tons of dancing lead by Alhassan who works for Work the World. The dancing was more like African Zumba but pretty fun.

We head out for our 6 hour bus ride to the funeral in Kumasi tomorrow at 7 am. 

Goat, chicken, curry rice, salad, African spicy sauce, and fish spring rolls 

7/9 clinic day

Another great day at the clinic. Today I worked with some of the regular patients . I used an ace wrapping technique for

Foot drop and to improve knee flexion for

The swing phase of gait and taught the patients wife how to do it at home to practice. 

There has been a few very strange cases while I have been here and one was a young girl who fell and after a period of events that don't exactly make sense  now has open wounds on her arm. Today in clinic the wound nurse came with her to change the dressing so I could see what it looked like. It sounds like a cast was placed on her arm and then 4 days later it was removed and a compartment syndrome occurred in her forearm and hand. After that she must have had some kind of skin infection because her fingers are no longer visible and all of her skin is not healing properly.  I have pictures but they are pretty graphic so I will not post them. 

I also got to do an evaluation today which was fun but hard because I had to use their format and terms and translator. It will take a few more to get used to it and feel comfortable.  After clinic 6 of us went to another orphanage. This one has 50 children who live there and 30 who live at home but receive help from the orphanage. I played soccer with most of the boys which was fun but showed how bad I am at the sport. This orphanage is larger then the other and has less support and help compared to the other. The age range of children is 5 to 17 and many of the older children come back and teach/ help out. 

Came back to house to have some Red red (native dish) and then hung out and watched Messi get the win for Argentina. 

Tuesday 7/814

Yesterday afternoon after clinic another student and I went to Kifo orphanage to hangout with the kids. They had 16 children between the ages of 4 and 16 with pretty nice facilities, volunteers, and well behaved children.  We played on the swings, played soccer, and worked on some English with the older boys. I spent a good amount of time throwing the younger boys up in the air and they loved it. It is nice to see a well run private orphanage with nice facilities. I plan to go to the larger once next week to see more babies and how it is ran. 

We returned to the house to find out that there was a possible case of Ebola (you can look up the medical condition online) in Accra. There has been an outbreak in other west Africa countries and an American traveler came to a hospital in Accra with similar signs and symptoms. The house was very worried and the director of Work the World house was in contact with the organization staff in the UK to figure out options if the tests came back positive. Luckily we found out last night that the results were negative and there are still no cases in Ghana. We will stay very cautious and be prepared for a return home if the risk becomes higher. 

Today I was the only student who went I to clinic from the house due to the scare. I had a great time working with a lot of patients. It was very busy so I jumped around from adults to children and back. I worked with many of the difficult or odd cases and also patients who were progressing and needed advanced ther ex ideas. The last case was a young patient born without a right radius and thumb. He had metal plates added to help form and support the wrist. At the end of the day I worked with the director and therapist to begin my CPI because Thursday I will spend the day in the HIV clinic and Friday we head to a funeral in Kumasi for the leader of our program in Ghana , Joe. His father passed away and we will be attending in support and to see a traditional ceremony. 

Tonight we had traditional Fante lessons to hep with speaking to patients in the clinic. 

Here are pictures of the clinic on the hospital grounds. It is a great facility and well maintained. 

New charts for patients