Monday, September 9, 2013

Marshall Islands: Kwajalein

So now having a few weeks under my belt at Kwaj, I can give a little update as to what things are like here!

We'll start with work.  So there is a small hospital here with maybe 4-6 beds, lab, ER, minor procedure rooms.  I have a separate physical therapy office a few blocks down, but I come to the hospital for a couple of meetings, getting scripts, etc a few times a week.  My little clinic has a gym, treatment room, and an office, plus bathroom and kitchen/laundry, so I am very nicely set up.  I have been doing my notes on paper due to the fact that it would probably take about 5-6 weeks for me to get a Computer Access Card (CAC), and by then I would be gone.  That being said, documentation is a breeze!  :)  I have mainly orthopedic patients, everything from total knee replacements, to sports injuries, to chronic low back pain.  Since ortho is my love when it comes to PT, I'm pretty happy.  :)  I have an hour/patient and can schedule however I need to to accomodate schedules.  So it's a pretty sweet set up!

My room ins in a BQ (Bachelor's Quarters) kind of like a hotel room and I eat in a dining hall.

As far as the scenery here on Kwaj, it's pretty amazing.  We have the Pacific Ocean roaring in on one side and a more protected, calmer lagoon on the other side.  There is plenty of coral, beautiful fish, lots of nurse and reef sharks (I did see a few small reef sharks on my last snorkel, but the bigger nurse sharks hang out by the boat dock and get fat with people throwing them fish guts after they go fishing...around here people act like they're big puppy dogs...).  The water is clear turquoise or dark blue depending on which side you're viewing.  Coconut palms abound (as well as the sign to watch your head for falling coconuts).  Coarse white sand lines the beach, but I think it is dredged a time or 2 a year.  If you're into watersports, this is amazing.  I've been snorkeling 5x in 4 different spots - 1 time before church, 1 time before work, and once actually when I didn't have to go somewhere afterwards.  I got to try wakeboarding once, which is TOUGH!  My forearms felt like I'd been doing a lot of rock climbing for about 4 days afterwards.  I only got up for a decent round once, making it through a straightaway and about half of a curve.  (Wakeboarding is like snowboarding while being pulled by a boat.)

So the social life here reminds me a lot of being aboard the Africa Mercy.  I see a lot of the same people at the dining hall at breakfast, lunch, and dinner, and you make new friends constantly.  It is also a very transitional island with people constantly moving in and moving out.  (Probably not as much in the fall-spring as the summer, however.)  You walk or bike everywhere...unless you're a paramedic, security, garbage man, or have access to a golf cart.  Thankfully Nikki, the PT for whom I'm covering, let me borrow her bike while she's gone.  For 1.1 square miles, it actually can feel like a long distance to get some places sometimes.  I think you can make a loop up to 7 miles long, or just "doing the runway" is about a 5 mile loop.  I've gotten to play some beach volleyball, done some swimming (they just drain and replace the pool with ocean water 1x/week), had some Zumba classes, ran, and worked out at the gym for exercise.    There is definitely a party feel - I think this is kind of like the Key West of the Pacific, except without all the good food.

Everyone is very nice and welcoming, and being a female there is no lack of compliments or chances to hang out with the opposite sex as the male to female ratio is quite some point I might get a big head and start to think I'm a supermodel or something...  ehhh, probably not.

There's also a great deal of history here, even prior to WWII, but I was blessed with the opportunity to get a tour with one of the island's archeologists on Roi-Lamur, a 30 minute (free) plane ride away from Kwaj where about 80-100 people work and live.  This is the island where the huge radar systems are to track missiles.  It has been explained to me that between the 3 radars on Roi they could count the droplets leaking out of the space station easily (if droplets were leaking...not that they were...)  It definitely zapped our golf cart a time or two and killed it...  Thankfully it restarted.  But there are many left over Japanese buildings, lots of graves (that have and have not been completely discovered), some post take over (you can tell my military terms are pretty scarce) American buildings.  Very interesting and neat to imagine how the battles took place as you're standing on the spot.
I am so thankful for the chance to have been the PT on Kwaj for a short while, the work and play combined fora great fit for me!

Thursday, September 5, 2013

Post Screening Day thoughts

So Screening Day was definitely a success...there were about 7300 people in line (including caregivers), and over 4200 patients were seen/screened by different surgical teams.  I don't know how many patients we screened in ortho - rough guess would be anywhere between 300-400 possible patients.  (We had about 125 +/- "yes" patients and it felt like we had atleast twice as many "no" patients.)  It was the biggest screening day in Mercy Ships history.

It was a tough day for Nick and I...Nick is my boss, an Australian physio.  Thankfully he's done some screening before as without our orthopedic surgeon actually being there it did fall to us to make the decisions of who was/wasn't a good candidate for orthopedic surgeries.  We did have several cut and dried criteria - only operating on children (who will heal up faster plus be easier if we need to carry them up/down the stairs while they might be in casts or nonweightbearing.  Also we were just doing lower limb surgeries, so no upper limb stuff (although some of those we were able to refer to the plastic surgeon instead)  For those needing a tendon release, criteriea were limited as well.

The reason it was a tough day was because we felt like we said no to so many people - many many possible patients that came through the line had cerebral palsy, and be it someone with low tone and decreased ability to sit/walk by themselves, or having more tone where they had very tight muscles that may benefit from a tendon release - most of those we had to say no to unless it was 1 sided and they had good strength and it would really improve their function.

So it felt like some stretches we had to say no to everyone...sometimes you would just be able to look at a person and know they were not a candidate, but you still wanted to treat them with the love and compassion that they need.  Yet at the same time you knew there was a massive line continually waiting for you to see them so you didn't have much time to spend.  But even if they couldn't have surgery I still wanted to give some idea of possible treatments that might help them, give a stretching tip, etc.  It was hard to find the balance of quickly yet compassionately caring for people and trying to answer questions they had - often it was like they were at a doctor's visit and would ask what else could they do and expectations they could have, but I felt very limited by time and even knowledge - not knowing what is available here in Congo as well as not being familiar with all the range of diagnoses that came through.  But I love it when people are proactive about their health, so I wanted to try to answer as much as tough.  Thankfully it was fairly cut and dried which patients we thought were good candidates for surgery, so atleast we didn't have to waver back and forth on decisions.

At the end of the day we had to put all of the heavy wooden desks back in the different classrooms we used, lifting them over banisters and cramming what seemed like way too many desks into a room, so that was a hard end to a long day.

So overall I really don't know how I feel about Screening/Selection Day.  I was very excited for it - I even had the butterflies in the stomach like before a big sporting event.  But the day itself is very difficult emotionally, because you know so much more could be done, so much more is the inequality between the western world and much of Africa and other developing areas.

I've been reading the Beatitudes recently, and it makes me think of these patients we had to say no to.
Blessed are the poor in spirit (discouraged), for theirs is the kingdom of  heaven.
Blessed are those who mourn, for they will be comforted.

Also, right above the Beatitudes it talks about Jesus healing the sick (Matthew 4:23-25), of Jesus healing EVERY TYPE of disease and sickness among the people.    And he healed them all.   So maybe Screening Day is also a good reminder that while we might have a lot of skillful medical practictioners, a lot of fancy equipment, and have the desire to help all the patients possible in West Africa, we are NOT Jesus.  We still need him despite our thoughts that we can handle some things on our own...
  My Mercy Ships family and home sweet ship...