The Jackson Clinics

6/15/11

Another rainy afternoon in Addis Ababa. This morning and early afternoon were actually quite nice, sunny and warm. But the clouds rolled in around 2:30 and it’s going to be wet the rest of the evening. Thank goodness for my rainboots!

I had the most amazing chocolate frosted donut for breakfast this morning at the hospital cafeteria. It was D-licious!

My first group brought in a woman who had fractured her tibial plateau during a car accident 2 months ago. For the last 8 weeks, she has been in a long leg cast, atrophying and stiffening away. She came to us with wooden axillary crutches that were way too tall and non weight bearing through the leg. As we examined her, she was very hesitant and anxious anything to do with her knee. I honestly believe that if I had not been there, she probably would have been placed on a modality and sent on her way to return for the next visit. However, after we thoroughly evaluated her, I started working on some gentle and then more aggressive joint mobilizations, followed by instruction with tactile cueing for quad sets, and 30 minutes later, we had increased her knee extension by 5 degrees. I thought this was very exciting, but our patient suddenly became visibly upset. After some chattering back and forth between the residents and the patient, I was informed that she thought her knee was never going to recover and that today’s treatment did not go very well because she had so much difficulty with the quad activation. This was a really good teaching moment for me because I was able to assist the residents in educating her that she actually performed quite well today. I also encouraged them to keep a very positive attitude with her and to encourage her along the way. We agreed to have her return tomorrow before the grand rounds presentation so that the entire class could learn from this case. Before I let her go, I insisted that the residents take a look at her axillary crutches and readjust them as they could for better ambulation.

The second group brought a patient who had sustained a surgical neck fracture of his humerus, as well as an undocumented clavicle fracture, 12 weeks ago during another car accident. As we looked through the chart, we are starting see good carryover of the prioritization of impairments and treatment techniques. We also observed documentation of previous treatments, although the details are still lacking. During the mentoring session, I was pleased to observe the residents applying the new assessments and treatment techniques to this patient. At the end of the treatment, we had gained 55 degrees of passive range of motion. Wintana told me, “55 degrees is a lot for me! I’m good with it!” There was some debate regarding what home exercises would be most appropriate, but what I am really pleased with is that they are considering the home exercise program for every patient.

Our group did a follow up treatment on the proximal humerus fracture that we have been treating over the last week. She continues to make steady progress, but what I am finding to be frustrating is the lack of enthusiasm and lack of initiative demonstrated by this final group, especially with the patient in front of them. It was a good opportunity to educate the residents on proper frequency of physiotherapy, as this patient is still healing at the fracture site and would benefit from reduced frequency until the fracture has been cleared with appropriate healing documented.

Our driver took us to ALERT hospital again today so Lili and I could go to the handmade gift shop on the campus. All of the items in this shop were handmade by the patients being treated at the hospital. We thought this was a really good opportunity to support such a good cause, so we each bought an item that were actually very nice and good quality. On our way out, we observed a man with no fingers weaving a mat using a loom. It was pretty amazing.

This evening we went to Top View Restaurant which has an amazing view of the city and had a very relaxing and delicious dinner. I had the lasagna and ice cream for dessert. It was a bit out of the way, but well worth the drive. Our cab driver, Ermias, is always good for interesting conversation and knowledge about the city.