Seeing the Fruits of Our Labor

It was another busy day in the clinic (have I said that already?!?). Today was my last full day in the clinic before beginning my journey back home.

We continued with the rehabilitation progression with Vilanese, the 35-year-old mother of four, one of which is a 10-month-old baby. She sustained an above-the-knee (AKA) amputation from the earthquake. She has been very motivated to get stronger so that she can return to her hometown several hours from the community where rehabilitation services are unavailable. Today, she was that much closer where she was able to walk with a new prosthesis around the clinic with crutches! She has been steadily working up to this moment, with strengthening and pre-gait activities, in the time that I have been there. It takes a huge amount of focus to walk with an AKA prosthesis as very little is automatic. Each small step of walking needs to be broken down into minuscule steps of weigh shifting, lifting and movement.

Giving training on prosthetic gait is challenging at best, with a 2nd language and an interpreter thrown in the mix, it is even more taxing. I wish I spoke more Creole (as a patient’s wife took the liberty to tell me today, “you need to learn Creole if you are going to live here”-agreed!).

Vilanese worked hard and stayed very focused. By the end of the session, she was getting the hang of it. I cannot wait to work with her again tomorrow so that she can walk around outside on the dirt and gravel terrain, the standard terrain around here. It felt good to be able to provide her with the skilled instruction to get her one step closer to her goal. There are several other patients who are close to being able to progress to prosthetic training too. We are waiting for the prosthesis for these patients so that we can begin the process for them too.

Sometimes you feel at odds on how to help a patient and caught between a rock. For practical purposes, Paul, another AKA, needs to use crutches to get around on the rocky and uneven terrain, though his handgrip is limited due to crush injuries to his hands. The one hand he has with a better grip, making it more functional, also has a fused elbow. What to do? We ended up building up the handholds, making it easier to grip and safer to use. These choices are daily decisions that you need to make here.

Dr. June was also able to consult on a couple of patients today to give me some ideas of what to do next. It was great to have her as a resource in the clinic for some of the time. She is the “face of the rehab program” though, so she no sooner got started on something before someone from the hospital or a community leader found her and she needed to resolve issues with him or her. She has a big job with many responsibilities. I hope sufficient PT volunteers will be found to support the program, so that she can focus on developing and supporting the program.