Plastics Screening Day

So Monday was a good day - we had screening day for the plastic surgeons to decide their final surgery list over the next month or two.  Now this is not plastic surgery like we think of in the west obviously...it's more to restore function and in some aspects form than it is to just improve aesthetic appearance.

So 50-60 patients were scheduled to show up, to be seen by 3 doctors.  We in the physio dept would add some insight (mainly Emily, our expert hand specialist), and we were also taking preop assessments to determine ROM, strength, and function so we would know what to compare them to post operatively. 

I also have a student this week from the ship's Academy.  The middle and high schoolers do a week of observing in different areas they are interested in such as nursing, PT, IT, media team, etc.  So Lara helped out tremendously by working with one of our dayworkers to get any patients with arm involvement to fill out the Quick Dash - an 11 question form that help determines function and pain of the upper limb.  We were trying to move so quickly in the morning, it was a little crazy because we saw them outside after they'd seen the surgeons, just trying to keep track of everyone and get the correct measurements was just a tad hectic (insert sarcastic tone ;) ).  But surprisingly, we broke for lunch relatively on time, and then when we went back, there were a couple things we had to finish, but we actually didn't have any more pts to perform preop assessments on, making the day overall much less crazy than I thought it would be!!  I then got to go back up on the ship with Emily to meet some of the pts who just had hand surgery a few days ago as I will be seeing them for the weekend coverage.  I'm going to learn so much!!!

As far as the pts who were seen for screening, it was very interesting hearing some parts of their stories.  One lady tripped and fell into a fire - and received bilateral hand, neck, and chest contractures that pulls most of her fingers into a very bent position so that she has great difficulty using them.  Because of her deformity, her husband then divorced her. 

Another 20 year old man has a long term ankle contracture - he was bitten by a snake (a big black one) when he was about 7 years old and had several days of "traditional medicine" which didn't work and then he went to the hospital but I guess it was too late/they didn't know what else to do.  So now he must walk on his heel and his toes point up in the air.  (Yet he can play soccer...just not with closed shoes on!!)

A male teenager had a massive neurofibroma creating a sac like tumor hanging off of his forearm.  Imagine that jello like stuff under your upper arms weighing 5-10 pounds and atleast as big as a (American) football and being on your forearm.  About 10 years ago he'd had it taken off at a local hospital but it's grown back...unfortunately that's often a problem with neurofibromas...

Just a few ideas of what kinds of patients would come to a "plastics" screening!

Since Monday, I've gotten a chance to work on the wards with the hand patients and with some of the other patients - a little girl who had torticollis with her SCM released (for all you med people out there), who has been really difficult to get to come out of that twisted neck position because she's been in it for what, 6 years or so?  Nana is a hand patient who thinks she's going to come back to the States with me...I told her she could get really small and then I could put her in my suitcase...she wasn't a fan of that idea, but we have a lot of fun joking around!

Please pray for these patients to remain infection-free, grafts heal well, and they regain as much function as possible!!!

Jesus had dirty feet

So maybe you've been to a church where you've had a foot washing service.  ComChap had ones around Easter in Richmond...  So you go, there's a basin of water, and you wash your friends' (or acquaintances) nice, already clean feet.

Recently, I have come to realize more what it would actually look like when Jesus washed the disciples feet or when the woman washed Jesus' feet with her hair.  My feet stay in a pretty constant state of dirty-ness.  Despite multiple washings...  Underneath the toenails, around the cuticles, I just can't get the dirt out, even if I'm wearing tennis shoes, somehow the dirt gets into the shoe and sock...  So imagine what it was like in Biblical times when the streets were not paved and they didn't have easily accessible running water.  Washing feet takes on a whole new meaning when you think of what it was really like. 

But to be honest, I would love to have someone really take the time to scrub my feet clean...I've been working on it myself obviously, but sometimes you just can't bend your leg up well enough for a long period.  I have been doing some feet cleaning myself today - when a person has been casted for months, basically a couple millimeters of skin on the sole of their feet will flake off with a little rubbing.  I had the chance to take the cast off (my best looking bivalved cast to date I might add...my casting skills are slowly improving) of a kid who is finally out of the cast after months, and picked off quite a lot of skin.  (It gets kinda addictive, like when you're peeling after a sunburn.)  He took his first steps with crutches out of the cast, and he was very excited to be done with the cast.  (His feet still needed some cleaning at home though...)

So contrast that with one of my favorite verses: "How beautiful are the feet of those that bring good news."    Or in context: Romans 10: ¹⁴ How, then, can they call on the one they have not believed in? And how can they believe in the one of whom they have not heard? And how can they hear without someone preaching to them? ¹⁵ And how can anyone preach unless they are sent? As it is written: “How beautiful are the feet of those who bring good news!” 

So when you think of Jesus' dirt-caked feet and how good the news was that He brought, I'm not quite so concerned about my dirty feet, but bringing the good news - most commonly for me that equates into: "You're healed enough to come out of your cast", or "You're improving, and I'm so proud of you".  But that's perhaps a little more shallow than I should be - the ultimate good news is that Jesus loves each and every one of my patients and coworkers, so that when I give the "bad news" of "there's nothing else I can do to help", "the orthopedic surgeon is no longer here", "we have to cast your child's feet again because they're relapsing into the club foot position" - if I could be intentional about sharing the true good news in the happy and the sad, maybe then I would approach having some beautiful feet...  Despite the dirt, plaster of paris and other random things on them...



P.S. Another thought on cleaniliness...  You know when you were growing up and your mother told you to wash behind your ears (I don't really remember if Mama had to tell me this often), and I always thought that was such a silly thing.  I mean, that spot never gets dirty.  Well, welcome to Conakry, where you get dirty behind the ears...TIA (This Is Africa).

Follow up on my cool patient story

So work has been going well - I'm starting to get the hang of things a bit more - I still am not very good about casting, but since many of the patients are getting out of casts at this point, it's more like what I would do in the States as far as restoring range of motion, regaining strength and the ability to walk.  We just got our new hand therapist in - Emily is from England and is very good at what she does as a hand therapist.  As we begin the Plastic surgery rotation in March, with another hand therapist coming in, I will get to learn a lot about contracture releases, scar management, pressure garments, splinting, etc.

So the exciting news of the week has been that the patient I wrote about earlier who has spina bifida, and then got menengitis, which actually was the healing factor for his cerebrospinal fluid leak.  So he's been doing so well with regaining his walking ability with a walker (we ziptied and duct taped a platform onto the R side because he didn't have much R hand function), but he started doing steps (our goal was 3 the first week but he did 16) and amazing us so we decided to try a trip to the Hope Center which is where the patients who live far away but still need outpatient care stay (a bed with a mattress underneath for a caregiver and a mosquito net over it all).  There are ~60 patient beds.  So Wednesday we made a trial trip (about a 10 minute drive when traffic is moderate), going down the 42 steps to get out of the ship, getting up in the back of a Land Rover with little assist.  We'll call him Abe for short.  Abe had such a smile on his face getting to the Hope Center and getting to see where his new "home" would be as he starts taking outpatient therapy.

Since last Wednesday was successful, Monday Abe was discharged to the Hope Center.  I heard a Land Rover leaving just before noon and figured it was him, seeing a hand waving out the back, I ran from the tent to send him off - they stopped at the gait and I got to wave goodbye a little closer. 

Monday night some friends and I went out walking and we just happened by the Hope Center and I got to check out Abe in his new surroundings.  He was happily sitting outside watching TV after dinner with the other patients. 

After walking down 42 steps!!  Myself, Emily (OT - now back in US), and Mom were so proud!!

Today he came for his first round of outpatient therapy.  We took lots of breaks, but worked on balance, walking with less support in the parallel bars, some fine motor skills with the weak R hand.  He'll be back tomorrow, so I tried not to tire him out too badly...  It's easy for me to go overboard (any former pts out there probably know I tend to push things if possible to the optimum).  ;)

Trip to Kindia

So the weekend of Jan 19-20, a group of 11 of us went to Kindia, the 3rd largest town in Guinea, which took us about 3.5 hours to get to (140 km away).  As we started driving out of Conakry, you could start to see mountains (YAY!!), so you know I was pretty happy.

We stayed near the farm where Mercy Ships help teach sustainable agriculture practices, like using animal dung and compost as fertilizer, crop rotation, etc.  It was very pretty.  We also got to try some of the "Miracle Tree" tea that comes from the Moringa tree that is supposed to be helpful for treating malaria (it was neat because one of my day workers had just mentioned it to me the week before) and has a lot of good things in it!  

We got to see a pretty awesome waterfall as well - here's a shot of the ladies!

And the waterfall up close and personal!

So I can't figure out how to make it right side up currently and I'm trying to hurry to get in bed, so that will do for now...  :)

We also got to do a little hiking of Mt. Gangan - so YAY for hiking as well!!  :) 

And of course I have to take a 'back' picture (well, I didn't actually take it since I'm in it, but anyways!)

It's very hazy because of the dust.  It has not rained the entire time I've been here (a month tomorrow!), so it is indeed the dry season (and we got our first batch of mangos on board this week - yay!!)  Anyways, I'm off to bed!  Running at 6:10 am tomorrow and hospital wide devotions at 7:30 make for an early morning!!!  :)

Some real heroes

So work in the rehab test wouldn't really work without the assistance of our dayworkers - Jeremy, Anama, and Faya.  Jeremy and Anama both started working for Mercy Ships when it was in Togo, their home country in 2010.  Faya is a Guinea native. 

Last Saturday I got to go play basketball with Anama, and along the way we passed where he lives.  It was about a half hour walk from the ship, and he had found a patient from Togo who had a brother living in Conakry, so he shares the room with him.  Likewise, Jeremy had to find a place to live in Conakry, so he sleeps in a nearby church with about 8 other Mercy Ships dayworkers.  For the first few weeks he just slept on a pew, now however, he's got a mattress that gets hidden during the day, and a mosquito net (I think). 

Without the translation help, plus the 100's of other things our dayworkers do throughout the course of a day, the rehab department would not exist like it does.  We would probably see 1/2 the number of patients and spend a lot more time cleaning and running up/down to the ship.  And all while loving and hugging on the kids that we make scream in terror, making balloons out of gloves, wearing hair nets to look silly, and playing pretend games.

So if you think the people that come and stay on the boat are cool, there's just as many awesome people staying off the ship getting paid very low amounts to serve God in their home continent, often still very far from home.  Our dayworkers rock!  :)

My first cool patient story...

Things have been going very well - I think getting here right before the new year was great because I had a few "holiday" days to transition in more slowly... this Wednesday I started seeing some patients with Nick (PT, my boss) and Emily (OT) and our dayworker Jeremy.  I got to practice putting on a cast with a baby with Nick doing most of the work and instructing what to do as he went along, and then Friday I got to cast Jeremy's leg, cut it off of him and off the cast on myself...

Casting Jeremy's leg

Nick and Emily casting the other leg

Cutting the cast off my leg

Cool story about how God works - one patient was down for a long time b/c he had a back surgery to improve the 'pouch' on his back due to spina bifida.  He had a cerebrospinal fluid (CSF) leak that would not heal up afterwards (a bad thing...basically he couldn't sit up or stand up without fluid kinda draining away from his brain), so he had to lie in bed.  Then he developed meningitis and was really sick - they didn't know if he was going to make it.  I met him Thursday for the first time, his mother stays with him as well.  (Most children have a caregiver with them - usually there's a mattress under the patient's bed that the caregiver sleeps on, but because the wards are relatively empty right now, I believe mama has her own bed.  But when Emily explained (partially in French and partially with the aid of a translator) that I would be helping care for her son from here on out, she gave me a big hug.  We stood with him a little to work on his standing balance - after a while his knees get tired and look like they'll give out from weakness of being bedridden so long.

On Friday, I got to help him walk (short distances 4x with 2 of us holding onto a gait belt, a hemi walker, and a chair following behind) with Emily for the first time in a month or more - and it turns out that the body's reaction to the meningitis was what jump started the healing process to actually allow the CSF leak to close up.  Sometimes our bodies need to actually be able to respond to a bad stimulus to improve healing (think Prolo therapy for those medical people out there...)  How cool is that!?  Just goes to show how awesome God is in allowing bad things to work out for good.  :)  Yay God!



This weekend I got to go out to a restaurant on Friday night with some live music by crowding into a taxi (actually it wasn't that bad, it was 10 people in a small minivan of sorts, did a tiny bit of dancing, ate some baraccuda (it was quite tasty!).  Since Conakry is a port city, obviously there is a lot of fish!!  In fact, on Saturday, I got to walk through the fish market again (there were about 8 of us...which was a little more obvious than the 2 of us last time I went), but there's just something awesome about seeing people making these large wooden boats by hand, mending nets by hand in long rows...  I have to say it's pretty neat to see.  There is a lot of fish for sale obviously, too - snapper, some kind of large stingray type fish, and tons more that I don't know (dorado?  I think I heard that mentioned.)  There are of course many smells to accompany these fish lying on dirty tarps, concrete or just plain 'ole dirt.

Notice the pigs in the trash in the bottom right...

Down on the dock after walking through the fish market

Mending nets by hand

I did laundry for the first time this weekend as well - 1st load and I already lost a sock.  Sadness ;)  It is a little funny to carry laundry through the ship - I live 3 decks away from the laundry...and I'm still learning which staircases do what, so I end up skirting through the hospital wards briefly.  The VVF (vasovaginal fistula) ladies are doing their hallway dance down and back with singing.  (Walking is good for them, so since dancing and singing is much easier to convince them to do, that's what happens instead ;) )  Most of these ladies have had a childbirth that they have been unable to recover from (I won't go into too many details because you know how much I dislike this subject ;) ) and most become outcasts in their area due to the inability to hold in bodily fluids, so this is their chance at a new start.  At the end of their time there is a 'dress ceremony' where the ladies are given a new dress to celebrate the start to a new life.  Pretty cool - I hope to attend a dress ceremony.  :)

Sunday I went to a local church, got to do a little dancing up front - think conga line...  :)  Still learning my way around town (of course, the part here by the port is tiny in comparison to the rest of the city, but I think it would be hard to get to via walking...)

Sunset from Deck 7

A little sight seeing

Since the first few days were fairly chill due to the New Year's holidays, I got to go on a boat ride to the islands across the way - maybe a 45 minute ride on a wooden boat with 20 some other Mercy Shippers.  I made such a graceful disembarkment as well once we got there by jumping off the end of the boat into shallow water, losing my footing and landing on my butt.  So much for staying dry!!

It was quite lovely though - beautiful sand, black rocks, greenery...  Steven and I managed to hike up onto a hill on the other side of the island and see all around.  And get sunburned...my nose is still recovering...

It cost 50,000 guinea francs (~$7) to go spend the day over there, though they like you to buy a drink or something to "use" the beach for about $1.40.