FARMville craziness

So currently I'm in FARMville, Virginia.  Yes, that's how it is written.  ;)  I am working for the very first time at a nursing home, or in PT terms, a SNF (pronounced "sniff" = skilled nursing facility).  When speaking with the manager during my phone interview, he told me they have a pretty good variety (I am still finding out that variety) and expect 90% productivity.  I had no idea he meant on the very first day.  So needless to say I was a little overwhelmed the first day with my 10 minute tour followed by a day of patients without even getting into the computer documentation system.  Thankfully all that has now been figured out, and I'm more in the swing of things.
FARMville is a super cute little town - a main street where most of the shops close at 5 or 6 pm, lots of fields, the smell of honeysuckle abounds.

I am renting a room from a lady who owns Arabian horses,
which I have now met once (I joined the YMCA, so I've been going there after work and it's usually about dark when I return).  There is 30ish mile trail nearby that I have gone down and back via bike last weekend, and hope to do the other half soon (FARMville is basically in the middle of the 30 miles).  Here are a few pics from the High Bridge trail, and you can see why I'm enjoying the scenery around FARMville - "it's so green, it's so green" to quote my mother ;)

The Appomattox river flows under the bridge, but the bridge is much longer than what would be needed to cross the river alone - the bridge is 2400 ft long and 125 ft high.  My trusty bicycle and I were able to conquer it, however.  ;)  The bridge used to be a railroad bridge, and during the Civil War both sides tried to destroy the bridge before Lee surrendered at Appomattox.  The bridge was rebuilt/repaired after the surrender, and had traffic on it until Norfolk Southern Railroad's last train crossed in 2004, then finally it was redone into a VA state park with a 30 mile trail system.  Pretty nifty!  :)

So back to that "variety" I was talking about at the SNF.  The patients have some CRAZY stories - because some of them are a little off their rocker, whether it be dementia, schizophrenia, or other mental illness related.  I've had patients tell me they've lived on Saturn, had an affair with Jesus Christ, have ESP, could ride motorcycles backwards (that one I believe), had a husband shoot at them (again, that one I believe), dated a gay porn star (again, this one I believe).  You also hear some stories that are sad about kids that didn't turn out well and they haven't talked in years, or they steal from their parents, as well as stories of questionable actions by family members or authorities figures when these patients were children or young adults.  Sometimes you laugh, sometimes you want to cry, but above all, you realize how despite what comes off as a little crazy, everyone has a story to tell, everyone has worth that is not governed by what they can do now, but who they are and Jesus loves them for who they are.  It reminds me of the passage in Matthew 25 separating the sheep from the goats:

³⁴ “Then the King will say to those on his right, ‘Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world. ³⁵ For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, ³⁶ I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.’

³⁷ “Then the righteous will answer him, ‘Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? ³⁸ When did we see you a stranger and invite you in, or needing clothes and clothe you? ³⁹ When did we see you sick or in prison and go to visit you?’

⁴⁰ “The King will reply, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.’

⁴¹ “Then he will say to those on his left, ‘Depart from me, you who are cursed, into the eternal fire prepared for the devil and his angels. ⁴² For I was hungry and you gave me nothing to eat, I was thirsty and you gave me nothing to drink, ⁴³ I was a stranger and you did not invite me in, I needed clothes and you did not clothe me, I was sick and in prison and you did not look after me.’

⁴⁴ “They also will answer, ‘Lord, when did we see you hungry or thirsty or a stranger or needing clothes or sick or in prison, and did not help you?’

⁴⁵ “He will reply, ‘Truly I tell you, whatever you did not do for one of the least of these, you did not do for me.’

There are so many times I feel limited in giving what someone asks for - on an hourly basis in the nursing home.  There is one lady who sits in her wheelchair in the doorway, and every time you pass by she says, "ma'am, ma'am, will you help me get back to bed?"  It's a struggle sometimes to pass by, she's not a PT patient, and if I take time to work with her I'll be missing time to work with my patients.  Or when I'm going to get a pt and someone else calls out from their room wanting to go to the bathroom who I don't know and I don't know how much assistance they need to transfer safely, to push the nurse's call bell when I know it might take 10-30 minutes for that person to actually get to the bathroom due to the demands on the nurses' time.  

Sometimes we are limited by different things, in this case I feel like it's time.  I pray that I can treat each of these nursing home residents like they are the Lord himself while doing what I need to do for my patients.  This week, I think that looked like pulling out the African tunes to get a little old lady moving and grooving.  However, I'm unsure of whether my attempt to bribe another pt to walk with sugar free peppermint patties was a good decision or not (it still didn't work, so she didn't get any...called me mean...what can I say, I'm a PT ;) )  Always learning.  :)

I will be starting my next adventure elsewhere on July 3rd as I start my journey to Kwajalein Atoll in the Pacific (think in between Hawaii and Papua New Guinea) for 6 weeks on an Air Force base!  I'm super excited to get back into a little outpatient and enjoy the island life.  woohoo!!  :)

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).