Therapy

My work here at Tenwek has mainly been acute care inpatient rehab. My typical day has matured to now I see the patients in the wards of the hospital while the other therapists handle the outpatient visits and any casting needs there are in the hospital. This can be a lot of work. My days are generally longer than what I would put in at the US and they are definitely more varied. I've mentioned some aspects of care in my previous posts, but I thought an 'end of our time here' reflection is now appropriate.
Differences between therapy in the US and Kenya:
1.) Casting- Here therapists are expected to be expert casters. I have only applied one cast by myself but I have helped the other therapists apply on average 2 casts each day. I have gotten a lot of experience with the cast saw.

2.) Prescriptions- The therapists can prescribe pain medicine and anti-inflammatories. I have been handing those responsibilities over to the other therapists.
3.)Traction Pins- Therapists play a big role in inserting traction pins into the limbs of children and adults for setting up traction to heal their fractures.
4.)Spica casts- They are everywhere. These casts position the patient with their leg out to their side and externally rotated. The casts typically go up the leg around the waist and part way down the other leg. Many are modified here to only include one leg to allow the patient to walk. Sitting is very difficult for these patients.
5.) Exercise- The majority of people I work with have no concept of exercise. Which makes sense, because they perform manual labor as their exercise. But the concept of continuing to bend your leg to make it be able to bend like normal seems to be a foreign strategy. They just say "it won't bend" and then don't work on it the rest of the day, despite my instruction. Then they get pretty aggravated at me at times when I make it bend, yes it hurts, but it is always the young men who get the most mad, I think it is a control issue. A huge issue with non-compliancy with exercise is my inability to speak their language. Most of the time I can get my point across with motions, broken Swahili and their broken English. Then I ask the nurse to translate the frequency of exercises, but often I wonder if the nurse understands how they really do need to do it as many times as I am telling them. The national therapist's default for frequency here is "do it 100 times a day." I'm not sure that strategy works either.
6.) Families- The families here seek me out to work with their beloved ones. After I do my initial evaluation the caregivers keep an eye out for me all day and are sure to remind me when I walk by that their child or mother or father needs to be seen. Another difference is the gratfulness the families display. It is definitely apparent. I seem to be able to bond quickly with patients and their families here. Whether it is from the guys on ortho giving me a hard time because I don't speak their language or the children beaming when I poke my head into the room, there are definitely relationships being built. I plan on blogging about Isabellah soon- she has been one of my biggest frustrations and joys on this trip.
7.) Assistive devices- They have to pay for them before they can get them. This creates a huge dilemma for me. I will train someone on crutches (which are used a lot more here than in the US) then I have to take them away until they can pay for them. Then I see my patient either laying in bed all the time when they could be walking, or walking on the limb that they are not supposed to be letting touch the ground. This is a frustration with the system.
8.) Diseases- There have been many times when the diagnosis for a patient reads malaria vs. typhoid or cva vs seizure or just plain unknown origin. Often you have to assume the patient has the worst to protect yourself from contamination. They do not have a CT scan or MRI here which makes definitive diagnoses very difficult in many cases. It doesn't effect my treatment much, just how carefully I wash my hands afterwards.
8.) The freedom to pray- There is such a joy and comfort brought to the patients by speaking the Lord's name and praying with them as they recover. Both the freedom and how comfortable it is to pray with the patients is different from the US. It has also shown me how many opportunities to pray with my patients in the US I have let pass by.

Despite the many differences between the US and here I am amazed at how God continually shows me evidence of the fact that we are all created in his image. People seem to be the same here versus America. We are all either sinners living in sin or saved by grace. There are strong, weak, tough, whiny, joyful, sad, excuse makers, and overcomers on my case load. Personalities seem to be evenly distributed, very similar to the personalities that I see in the US. I am able to bond quickly to fellow believers and have barriers to overcome with angry or resentful patients, but they all appreciate and seem to recognize genuine care.