Guinea's beautiful scenery: Kassa

On another long weekend - the ship has scheduled long weekends about every 6 weeks where those people that do not HAVE to be there for patient or ship care can get a little more of a break.  Nicole's birthday was right before one such weekend, so we took a little trip to Kassa, one of the islands, and stayed in a hotel.

The island in the distance is Roume, the other island I got to visit about 3x while in Guinea.

Our little section of beach, but we explored both directions a bit more, having fun playing on the rocks and seeing other MS folk set up in a hammock camp further up the beach.  

 It's hard to get enough sunset pictures...  In the daytime though, I got to take a run through the fishing village Juan and I had explored on an earlier trip to Kassa.  A couple little girls tagged along for a portion of my run, and as a found myself on a road unsure if I was heading back towards the hotel or not, I came across about 6 other girls from MS who were looking for a good place to camp for the night.  I directed them towards a good spot on the beach, and they said I was on the right track towards the hotel.

Our casita for the night

When the tide went out, you could actually see all the rocks you stepped on while the tide was in.  I managed to swim out to a big rock during high tide, but as the water receded by the time I swam back I ended up scraping my stomach in the 6-12 inches of water over the rocks.

It was great just to have time to relax and enjoy the scenery, without anything we HAD to do except sleep, explore, eat and read if you brought a book.  Although we did try to solve the world's problems one night...

Guinea's beautiful scenery: Dalaba

Also wanted to show just a few more of the beautiful sights from Guinea...

In March I was able to get off an extra day from work and Melodee found a car for us to rent, so she, Steven, Juan and myself got to go up to Dalaba, about 8 hours upcountry.  Melodee grew up in Guinea and spent several of her younger years growing up in the Fouta region, which is where the mountains are.  :)  and we know I like mountains.  :)  She took us on a tour of her favorite spots: good places of play on rocks, where to eat good dinner, deer meat from roadside stands, the best fresh made yogurt I've ever eaten (we literally just slurped it out of the cups), a pretty cool waterfall, picking strawberries, and much more!

The town of Dalaba - little Switzerland back in French colonial days

A pretty good perch to watch the sun go down...

Sunrise from the cabin was also pretty spectacular

We got up early in the mornings in hopes of seeing the monkeys as they came down the mountain to the valley.  No luck either day, however the 2nd morning we heard the deep bark of an alpha monkey.  I might have gotten a little bit nervous...imagining monkeys jumping out as we trekked down the trail to the cabin...

The next day we hit up a farm and had fresh carrots, strawberries and something kinda like spinach, and I made a tasty salad.  I was honestly very excited because I had just been talking about how when I returned home I really wanted a strawberry spinach salad.  And I got one a lot sooner than I expected!!!
As we traveled up country to the waterfall, we passed by Pita, which is where the amazing yogurt is, but also home to Guinea's own fabric makers.  They have a distinctive weave pattern of blue and white, kind of a linen type feel.  Juan and Steven bartered for a bit, but it was a bit pricey, so we got a couple pictures instead :)  You can see how long the looms are set up to make the fabric.

We spent both nights in a cabin run by the Christian Missionary Alliance, having a bonfire both nights and making a delicious new smore version of tortilla, M&M's, and a roasted banana :)   I got a little carried away with the time lapse feature on the camera and made multiple attempts at writing things with my headlamp...Juan's version of Jesus turned out the best though.

The waterfall at Sala was an adventure to get to, then of course a pretty awesome adventure to explore, jump off rocks, see how far out on ledges we could get, etc.  

So needless to say we had a fabulous time, despite the long long drive, and I'm so thankful for a chance to see a little more of upcountry Guinea - this area was inhabited mainly by the Pular tribe, which came down into Guinea >100 years ago, bringing Islam, and displacing the Kissi tribe (I learned this part from Faya, our dayworker who is Kissi) to further into the forest region.  The Pular have been very successful with their farming in the area, and the potato capital of Guinea supplied us with delicious potatoes!  (We had fried potatoes one night and they were amazing.  Or maybe we were just hungry...)

Reflections on my last month in Guinea: Follow up on Plastics

So I've been home now 4 weeks, started a new job, gotten back in the swing of things somewhat.  I would like to give a bit of a synopsis of my last couple months.

Continuation of Plastic Surgery Rotation:
For the first time, I got to work with many patients on the wards inside the ship instead of in the outpatient tent.  For 50-75% of most days I was on the ward for a couple weeks, getting to work with Emily and Sharon, both hand therapists from England.  I tried to absorb as much of their knowledge as possible, as hands are not an area that I have much practice in!  Many of the patients had burn contractures that were released by surgery.  I got to stand in for a different type of surgery, one in which Dr. T was taking a patient's index finger and transposing it to the area in which his thumb should be.  Mamadou's hands and forearms were malformed at birth, very twisted and only having 4 fingers on each hand.  He now can oppose and hold things in his hands - he was playing cards holding them in his operated hand (his other hand had been "done" in the fall).

Em and Mamadou before surgery

So I got to work with many of the patients who had a release of their armpit - probably my favorite (and the favorite I think of many of the moms of the young girls) was a former street dancer until he was burned about 1 1/2 years ago in a house fire in which 2 other people died.  He was in the hospital for about 5 months due to severe burns on his arms and back.  When he came to the plastics screening, he could bend/straighten his elbows very little - unable to get his hand to his mouth, unable to raise his arms up above shoulder level on both sides.  After his surgeries, it was a 3 person job to make 2 airplane splints and while he was in so much pain just a day or 2 post op.  However Ous was a trooper and we finally got it made up.  While in the treatment sessions, sometimes I would get to snag about 4 patients who had had upper limb surgeries and we would hang out in the stairwell of the hospital and dance.  I'd get Ous to pick out a song from his phone, and then I would "lead" my little troupe in a couple songs, focusing a lot on getting the arms up overhead, but just trying to move as much as possible.  I'm sure it was quite comical...but I had a blast.  The patients seemed to enjoy it as well.  Another reason Ous might have been a favorite of mine was because I would go on a run or bike ride early in the AM and go past the Hope Center on my loop which is where the patients that lived far away stayed in Conakry after they were released from the hospital portion of the ship, but still needed to return for outpatient treatments (wound care or therapy).  Twice I saw Ous was outside by the Hope Center gait at 6:30 am doing his exercises.  Now if that doesn't make a PT's heart happy I don't know what does.  I had to brag to my teammates on him, and he had excellent outcomes, full passive shoulder ROM, and improving elbow flexion.  While he seemed to still be lagging behind on the elbows, one day Emily thought we could just strap him in for more of a prolonged stretch - so we found a baby sling and rigged it up around his neck to pull his hand in.  He had it on his R arm for probably 30 minutes or more and when we took it off, he wiggled it around then put his hand on top of his head, then slid it down his face - you could see the smile from behind his hand however...  I asked him, "le premier fois?"  (the first time), and he nodded yes.  Again, things that just make your heart smile as a PT.  Thankfully we just happened to have some cookies in the tent that day and got to watch him go hand to mouth for the first time in 1 1/2 year.  WOW.  :)

Ous and I at the Hope Center

Another good story of plastics was the development of my nickname...in its various forms: French, Susu, Malinke, and even Pular eventually - respectively:  Bonne travaille, Eh baga wali, Eh barra barra, Eh goulee (I have no idea how to spell those translations...)  Apparently I told my patients "Good job" a whole lot.  They picked up on it.  So when I would walk down the hallway, as patients (or their moms) would see me, you would hear a chorus of "Bonne Travaille!", and then I would yell out some other version of the same.  I don't think any of the patients except my special friend, Nana, knew my real name.  At one point Emily was treating a patient in the inpatient treatment room, she told her patient "Good job" in French.  The patient then looked up to the door to see if I was coming in.  Crazy!  :)  Papanie, one of the other crew, was dubbed "Move It" because of his tendency to sing "I like to move it, move it" when he visited the wards (think the song from Madagascar the movie), so I guess it could be worse...

I'm back...well, have been for a bit!

So as I've usually noticed with other people's blogs when they come away from a big trip, there's a lot of stuff to do, a lot of things to think about, when you're preparing to leave and then when you come home.  So often a lot of people wait for a while before they write a blog.  Apparently I'm in the same category...
I think that's because you have to process, and for being an introvert, I really hate processing...strange, huh?  Maybe it's because it means that you're really gone, even though you want to still be where ever it is you were...Guinea in my case...   There are so many things that I do as a force of 3.5 months of habit - turn off the shower water, try to run the faucet water a couple seconds if it's the middle of the night so the suction won't turn on and wake everyone up (oh wait, there's no suction in the faucets here...), say "Voila!" a lot (and that's not even one of the words we discovered on the rehab team that I say a lot...apparently so!)
So that being said, I'm not writing a lot right now...mainly because then I would be procrastinating from preparing for the presentation at church tomorrow, but I will this week hopefully!  
Job update - I will be working at a SNF in Farmville, VA from next Friday through July.  Then in July I'll spend a few weeks in the Marshall Islands as the PT there goes on vacation (super excited about that one - tiny Pacific island, prime snorkeling location, and the furthest west I've ever been!).

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).  ;)