(Warning-this is a heavy read blog entry, reader viewing advised for the faint of heart).

Another full day of patient care again today. One thing that has been disheartening is seeing the lack of preventative care, continuing care and post care with our patients. I am impressed with how many patients I have seen who have suffered strokes, many in young ages, of something that can be prevented on many levels at home with hypertension medications. The people simply don’t have the access to screening, medical care and maintenance medications, and as a result, suffer from conditions. Many, after suffering a stroke, do not have access to rehabilitation.

I have been surprised by how many patients I have seen who have had a stroke several years ago and then received therapy, so that they don’t know even the basics on how to transfer independently into a wheelchair or use their body to get into and out of bed. As a result, they have placed a greater dependence on their family and confine themselves to a bed or wheelchair unnecessarily. Their uninvolved side becomes weakened also from de-conditioning. There is no safety net here of social security, so people who may be able to continue to contribute to society are not able to do so due to the lack of rehabilitation care. They become an increased demand on the already limited resources of their family. The good news is, that even a couple years later, patients can still benefit from therapy as some of it is just learning a motor skill and re-strengthening unused muscles. In fact, I am surprised that with just a little initial therapy even after so much time has passed, a person can make an improvement.

Immobility after an orthopedic/bone injury is a different story. As patients are not given the information, of when to begin moving and how to begin moving, joint contractures form and are not as easily overcome. One young man needed to have his below-the-knee amputation excised to an above-the-knee amputation due to a knee contracture making it non-functional to begin prosthetic training on. He will be able to gain a functional gait once again, but the energy demand of having one less joint to do the job of locomotion will be taxing.

Yesterday, I provided some Tylenol to a Rehab Center worker running a high fever who did not have access to even this basic medication. Earlier, a colleague provided some Tylenol to a patient who had a recent amputation. Vicodin is available back home and costs pennies a pill, but yet is not available here to humanely manage the post-op pain.

Another barrier is the unnecessary results of infection due to the lack of sanitary conditions, access to antibiotics when an infection sets in, and in some cases, knowledge on how to provide basic medical care and first aid. Conditions that could easily have been managed with conservative medical care now necessitate an amputation. The results of this are truly tragic. In an ironic way, the earthquake may bring a silver lining, with increased aid workers coming in and becoming more aware of the needs to provide needed training and resources.