Last Day!

Today was our last day at Chidamoyo. It doesn't feel quite real yet even after our goodbyes today. We both will miss Brighton and everyone else at the hospital and are sad to have to leave so soon. That being said, today was the best last day we could have asked for. We visited a nearby school this morning and saw patients with a variety of conditions, some of which we hadn't seen before. Even though we weren't able to treat some of the patients ourselves, we are hoping our advice will be the push they need to come to the hospital to be diagnosed and treated. We saw some interesting cases today such as a young child with an intention tremor, a child who had four fingers amputated after a trauma, and a younger women who had developed scoliosis and hip pain after a history of osteomyelitis. After we finished treating patients, the  school staff made us lunch which was so thoughtful and very appreciated. We then visited the nearby primary school (grades 1-7) where the children there recited poetry for us and performed traditional African dances. It was an unforgettable afternoon. After returning to the hospital, we saw our very last patient (who was a nurse at the hospital) and gave her some exercises as well as modifying a lumbar support brace into a SI belt to help provide compression which reduced her pain. Then it was time for a final photo op and goodbye with Brighton before heading home. Today was a day of tough goodbyes, but also was very rewarding to feel like we had connected with so many people and had made an impact here! We will post some more thoughts on our experience over the next few days!

Primary school visit! 

Sustainability

(Written by Kaeli) 

One thing Kendra, Anne and I wanted to make sure, was that this GROW trip to Zimbabwe was sustainable and not just "voluntourism". We didn’t want to come and build something that would be obsolete once we were gone, or to so we have focused our time and efforts here on education.

Today we gave three presentations. The first was to the hospital patients and staff about chronic low back pain. We covered posture, core engagement, exercise progressions, rescue stretches to relieve pain, sleeping positioning, and lifting body mechanics. This was a fun presentation to give, especially when we asked for volunteers from the audience. There was lots of giggling when we taught pelvic control!

The second presentation was for the village healthcare workers from around the area regarding motor development and signs a child may have a developmental disorder. We emphasized teaching parents the possible causes of these disorders and that they are not to blame. We gave them a chart that they can keep for reference and Brighton told them that they could bring the children straight to him instead of going to a doctor instead, which received a round of applause. Anywhere got to share about his support group, and it wa very well received. After our meeting the village healthcare workers met amongst themselves and designed a plan for how they want to move forward with the disabled community. First they asked for more educational workshops, second they wanted to see if we could support them with bicycles for some of the workers who have to travel 10s of kilometers by foot to visit children's homes. They also wanted to raise awareness about disabilities and the support group to help reduce stigma. It seemed to me as though our meeting had started a snowball effect and a fantastic discussion. This is something for Friends of Chidamoyo or GROW to consider raising money for. It would be about $70 per bike. More to come as we assess the need.

The third presentation was the motor development info, but modified for the potentially less-educated pregnant mothers. We spoke to 56 mothers who live on the hospital campus waiting to give birth (they do this to make their birth safer, as many of them live a day away). We had a positive discussion with these women as well about the causes of developmental disorders, the importance of early medical treatment, and the ways they can support each other and reduce stigma in their communities.

A tiring day of public speaking, but we were encouraged by the enthusiasm of our audiences, and the knowledge that our work was the most sustainable it could be.

Malnutrition, a Cesarean and Spoons

(Written by Anne)

Today started out with attending the hospital staff meeting. The visiting medical students gave a presentation. It was really interesting hearing some of the suggestions they gave on documenting more consistently and discussions on resources available.

After the staff meeting, we saw a number of orthopedic patients in the clinic. Kaeli and I both really enjoyed the problem solving involved and working together to diagnose and treat thoracic outlet syndrome and tricep tendonitis. Right after tea time (yes, tea time is a daily thing!), Kaeli and I were given the opportunity to observe a c-section that ended with a beautiful baby girl entering into the world!

In the afternoon, we saw two patients in the inpatient department with second and third degree burns. The first patient was a young child, so we had to be creative to incorporate play into the stretching and positioning that we wanted. We also worked on our motor development handout in the afternoon that we are planning on giving the village healthcare workers during one of our presentations tomorrow (we have three!). Brighton was kind enough to translate our handout into Shona. We also have been working with Brighton since we arrived on creating a list of things that the rehabilitation department at the hospital needs. We are hoping the next students that visit Chidamoyo may be able to bring some of the items on our list. We will be sharing our list when it is complete, so stay tuned! The day ended with a run with Kaeli (with lots of young locals laughing because they aren’t used to seeing runners!), dinner with the medical students, and a very loud game of spoons. It was so fun getting to know them better and learn more about medical school in Zimbabwe. Today was an amazing day at Chidamoyo and it doesn’t quite feel real that we only have two more days at the hospital! 

Tomorrow will be a big day for us. Kaeli and I have not one, but three presentations. We will be speaking to the hospital staff about exercises to reduce low back pain, then the healthcare workers who work in the villages will be coming to the hospital to hear our presentation on motor development and signs a child may have a developmental disorder. Lastly, we will be giving a very similar presentation to the expecting mothers staying at the hospital (about 50 women!) on motor development and signs they should take their child to be seen by a healthcare professional. Wish us luck! We will update you tomorrow on how they went!

Developmental Disorders and the Consequence of Stigma

(Written by Kaeli)

            Our day began with a drive out to a nearby village to visit with the village healthworkers and any disabled children that needed to be seen, but it led us down a surprising path. The village healthworkers told us that there were many children that needed us, but when we arrived there was no one to be seen. As cell phones are not very common here, we had to then drive around to different people’s huts asking if anyone knew where the children were. We finally saw one of the healthworkers running through the bush towards us with a young boy. She explained that there was one mother in her town that was unable to bring her son to meet us, as the child had Cerebral Palsy, was still not able to walk, and was too big to carry.  Another mother in the village was not willing to bring her child out to see us because she was ashamed. This opened up a very real discussion with Brighton (the Rehab technician with whom we have been working) and our driver, Makaza. They explained to us that many of the local people view physical disability as something that is either the fault of the parents, or a product of witchcraft and that since they don’t understand it they may shame the parents of a child who is disabled. For this reason, many parents will choose to essentially hide their children from their communities, rarely letting their children out of the home. For those of you who read earlier blog posts, a theme is developing. We are seeing that the stigma around physical disabilities is deterring proper treatment of these children, and perpetuating a cycle. If the children don’t receive interventions then they are less likely to be independent and to participate in the community, but the fact that they don’t participate in the community already keeps them from accessing medical care and subsequent necessary interventions.

            While this is a difficult situation to begin to understand, we were heartened to hear that the village healthcare workers wanted to help break the cycle. We discussed importance of spreading awareness about the causes of developmental disorders so that the blame could be lifted off of the parents, as well as the positive effects of early intervention (See tomorrow’s blogpost by Anne.)  We also learned that a support group for disabled children is forming, and we met with the village healthcare worker who started the group, Anywhere. He said he noticed that it was easier to get parents to bring their children with developmental disorders out to meetings if they were told there would be other families with similar issues present. We encouraged him and talked with him about the success of similar groups in the United States. There is a long way to go, but I think progress is on the horizon! With a little financial support to help Brighton make more village visits, and to provide more assistive devices like wheelchairs and pediatric walkers, I think a tipping point could be reached.

            We only saw one patient for our village visit, but it was very informative and worth the drive for the discussion and brainstorming that followed. There were plenty of patients once we returned to the hospital to finish out the afternoon.

            

A Heartbreaking Morning and a Heartwarming Afternoon

(Written by Anne)

Today marked the end of our first week at Chidamoyo. Today was difficult because we found out that the 5 yr old girl we had worked with and wrote about in a prior blog post had passed away last night. We did the best we could to provide each other with the support we needed to start to process this news and then focus on providing the best care we could to our patients today.

Not many patients came into the clinic this morning, so we spent it working on making an outline for a handout we are planning on giving the village healthcare workers. We will present on developmental milestones and signs to watch out for that mean that a family should take their child into the hospital to be seen. We are hoping that education about early signs that a child may have impaired motor development will allow for children to receive earlier intervention and have overall better outcomes.

In the afternoon, the older man who had taken us to his home yesterday to visit his son with cerebral palsy came to the hospital and we gave him a gait belt and wheelchair to use to help with being able to transport his son to the field where he works, so he no longer would have to spend his days locked alone at home. It was very touching when this quiet humble older man thanked us for all of our help and told us how he would no longer need to lock his son inside when he went to the field to work, but instead could now take him along. He told us that the way we taught him how to help transfer his son was so much easier for him and felt this would keep him from being injured and allow him to take his son to more places. It felt very rewarding to feel like we were able to make a significant difference for this family.

We saw a number of other patients later today, including many patients with orthopedic conditions. Treatments we provided included different taping methods, therapeutic exercises, and even making a modified cushion for someone with coccygeal pain. The plan for tomorrow is to observe rounds in the morning and re-visit a small child in the inpatient pediatrics department with Cerebral Palsy. We will give the mother some additional ideas to encourage progress towards developmental milestones and give some additional advice about how to manage scar tissue from a prior surgery the child had to treat osteomyelitis. 

Update: We heard a couple days later that the man had gone home and immediately wheeled his son down to the township to show his neighbors. Apparently he was saying, "this is the first time I have taken my son for a walk outside". And that folks, is what it is all about. (Tears in my eyes.)

Our First Home Visit

(Written by Kaeli)

Today we visited a remote village where all the village healthcare workers had told the families to bring in their physically disabled children to see us if they wanted. They put us up in a school room, it is hilarious to see the fascination all the children have for us, they crowd around the windows and push each other to watch us until their teachers reprimand them!

 Families gathering for immunizations and other medical care.

 Our makeshift treatment tables. This was actually pretty effective!

 Teaching a mother how to work with her child on head control with graduated challenge. 

 Kendra had treated this little boy when she came two years ago! She said he had made huge improvements! We worked on core control, crawling, and walking with him! That smile.....

One old man was catching my attention all day. When all the other children had gotten their turn with us he stood up and told us that he wanted to bring his 20 year old son but since he still cannot walk he would have had to carry him on his back, and when he tries to do that his son bites him. We agreed to drive him to his home so see what we could do. Their home consists of a slightly cleared rocky spot and three small structures. One is a small dirt floor thatched-roof room where the child was locked in (probably for his own safety). He has cerebral palsy and was spastic, but the father assisted him walking outside. He was too shy to interact with us, so we had to teach the father how to do transfers and assist walking to the toilet and such and use me as a demo. The old man laughed so hard when he realized I wanted him to practice lifting me (with better body mechanics of course). We even made a makeshift gait belt out of a Zambia cloth (a large piece of thin colorful fabric). The young man (Kenny) was dancing to music inside his head and when we played him music his whole body got into it- it took him to another world. Talk about how powerful music can be!

A few of the adults in the community have formed a sort of coalition to band together families with disabled family members. They want to organize getting mats for children to lay on, and wheelchairs. I also think gait belts would be helpful so that the parents could better transfer them. 

We saw 4 more patients when we returned to the hospital-more straightforward orthopedic issues like casting. Today was another exhausting day, with a village clinic, a home visit, and some hospital work. It is so good to feel like our time here is worthwhile- I think we are really bringing awareness to the communities, teaching Brighton some techniques and skills, as well as learning so much ourselves. Anne and I learn so much from watching Kendra take on these incredibly challenging patients and break the case down into simple, manageable things to treat and teach the patients. And then in addition we all learn so much about the challenges of quality healthcare in a country with such little governmental support and such extreme poverty. 

"Zvakanaka" Means Good

Today was another day of seeing patients at the hospital. Activities included gait training, referral for medication review, bracing, and patient education on positioning.

We were very thankful for Kendra's expertise and supervision especially in the afternoon, when working in inpatient pediatrics with a young girl with probable bacterial meningitis. She talked us through positioning to reduce extension patterns using neurodevelopment treatment principles and it was incredible to watch the drastic improvement in the child's breathing pattern and signs of distress immediately after positioning her neck into more flexion.

In between patients today, we learned from Kendra about ways to manage tone through serial casting, orthotics, and shoe modifications. Brighton taught us many things about how the healthcare system works here, emphasizing differences in the way patients pay for services, and the differences in treatments available to patients. Tomorrow is another day of community visits and we may also have the opportunity to assist a clinic in their outreach program doing child wellness checks. Pictures still to come!

Kendra reviewing resources with Brighton in the clinic.