The Jackson Clinics

6/7/11

Today we toured Alert Hospital, which is the Leprosy and Tuberculosis rehabilitation center. The compound is kept up very well with fresh flowers and lawn maintenance, which contrasts with the lower income and unemployed patients that seek treatment there. We met several of the PTs, Tiramsu and Negit, and finally, the Director of the Physiotherapy department, Demis, who each described to us the type of patients that they typically treat in this department, which included leprosy, car accidents, stroke, cerebral palsy, and congenital deformities. During our tour of the unit, we excused our way through the crowds of patients and their families as they waited for treatment. Their largest treatment room, which is about the size of the Worldgate clinic, was where they treated hand patients. There were seven tables throughout the room with three small wooden benches arranged around each so that the physiotherapist could sit at the other end and work with multiple patients at a time. What disturbed Lili and I the most about this set up was that patients were sitting around each table and wiggling their fingers, occasionally. There was no skilled exercises being performed or instructed, nor was their equipment for hand stretching or strengthening. I had the opportunity to talk to one of the PTs, , while he was massaging and gently stretching an 8 year old boy’s arm (2 years s/p radius and ulna fracture which had caused nerve damage) about the services that he provided. He talked about his treatment plan (massage, stretching and splinting) and then proceeded to interview me for 10 minutes (during which he had stopped working with the child and with the other 4 patients around him to direct all of his attention to our discussion). I thought to myself, my patients would likely complain, switch therapists, or never return if I did this at home… WOW! We were taken to the modalities room where I witnessed a high level runner receiving infrared treatment for his shoulder (he would receive massage and TENS before leaving), a lumbar radiculopathy patient with numbness below the knee receiving infrared, and a sciatica patient receiving TENS for his entire involved leg (he would receive no other treatment today until the pain resolved). As I asked Demis about the plan of care for this man, he became very defensive to my innocent question regarding the progression of care and assured me that this patient was receiving the best care. In the casting room, I observed a physio applying Plaster of Paris to a 1 month old’s leg to begin serial casting for clubfoot. Towards the end of the morning, we were able to sit in on grand rounds, which included a plastic surgeon, an orthopaedic surgeon, an occupation therapist and 2 physiotherapists. They discussed two cases; one involving a two year old with a very mild of case of cerebral palsy for which they determined splinting and stretching would be sufficient; the second involving a teenager with a congenital deformity of the little fingers (presentation similar to a swan neck deformity) for which they determined they would perform surgery to release the soft tissue restrictions.

From this experience, I am so grateful for my education from Duke, my mentor, Ken, and all of the other residency mentors and instructors for their clinical expertise and research that they have shared. It was very hard to not step in and change the plan of care where I saw potential, as I witnessed treatment after treatment, knowing that any modifications could not be carried over. While talking to the physios at this hospital, there was a strong sense of desire to know more, but at the same time, unwillingness to make those sacrifices to create change. They strongly desire for instructors to come to their unit for education and mentoring, but believe they are too busy to give a day and a half per month to travel to Black Lion Hospital for continuing education. Two of them expressed interest in pursuing scholarships to the U.S. and another hinted that he was preparing for another profession out of frustration and poor job satisfaction. There is so much opportunity at this hospital, but I’m not sure what can be changed until there is a change of heart.

This afternoon, Lili and I traveled to the National Museum of Ethiopia were we got a tour from a young man for about an hour. We saw a replication of “Lucy”, a collection of skulls demonstrating the evolution of man, and then a collection of historical pottery. This was a touristy place and for someone who lives 20 minutes from the National Museum of Natural History in Washington, D.C., it was a good time filler but not highly recommended. Our very friendly and English speaking cab driver, Ermias, is fantastic and very reliable. He drove us from the apartment to and from the museum, and waited for us in the meantime. He stopped along the way home so we could meet his 9 month old daughter who is very cute.

As we finish day 4, I miss my family, my boyfriend and friends and I feel very isolated without my phone and 24 hour access to email. Perhaps this is a good thing, as I am learning to be less dependent on instantaneous modern communication.. My back is in very poor shape from all of the standing and waiting for transportation. And the bad news for today… I am very sick, but at least we have running water. =)