This is Why...

This week we had the last day of orthopedic screening in Tamatave. Surgeries began which meant the hospital was open for patient care! Rehab team had a great week overall getting into the swing of things with some outpatient coming for treatment of their clubfeet; some coming for their pre-operation assessment; and some patients being treated in the ward after their surgeries. 

This is one of the boys who was selected to have surgery waiting patiently in the general screening line. Photo credit to Mercy Ships

One of our jobs it to take measurements of strength, range of motion, and functional abilities prior to surgery. It is important to document a big overall picture of the joints and spinal alignment and strength on paper. Most of the physiotherapists here now will not be the ones discharging the patients (sending them home in several months at the end of their treatment). We take turns performing these. Each day, one of us will have the chance meet the children the day before their surgery. It is a joy and challenge to make them feel comfortable and get all the measurements when they are young and often scared. The day workers have been so helpful with playing them while we get the information. Balloons and speaking to them in their native language usually works wonders.

This is a little girl who was here for her pre-operation assessment. Hard to get a smile. (Photo credit Mercy Ships)

This is her a day or two after surgery. Skilled surgeon, loving care from nurses and challenge and love from rehab go a long ways. (Mercy Ships photo credit)

I met this little boy at general screening. His smile and joy for life made my day. He was such a blessing to me (Photo credit Mercy Ships)

Although everyone has an important story, each year Mercy Ships chooses a few to highlight. The little girl below is one of them for this year. I had the privilege of performing her pre-operation assessment. She entered with a stoic face. After batting a balloon back and forth for awhile, she did eek out a smile. It is those smiles that let you know the patient has allowed you to enter their world even if just a little bit.

At her home. This was her facial expression when I met her at pre-operation assessment. (Photo credit Mercy Ships)

Her and her sister at home. I got a little glimpse of this smile.(Photo credit Mercy Ships)

Her foot is in this position as it is paralytic secondary to an equinine injection used to treat Malaria. (Photo credit:Mercy Ships)

The Rehab team has a unique place on the ship. We are able to follow the patients from screening, admissions day, first day post op, through cast changes and outpatient rehabilitation, and discharge home healed. It is very neat to be able to be with the patients throughout we watch the transformation of mind, body, and spirit unfold. Sometimes quickly; sometimes slowly.

This week, I was able to continue practicing cast skills. Casts are applied at the end of surgeries by the surgical team. Due to the trauma of the surgery, the leg or foot often responds with swelling. The swelling is compensated for by bi-valving the casts (cutting both sides open). It is then overwrapped with an Ace bandage. This way if the swelling increases the nerves and arteries are not compressed. After a day or two, the swelling has decreased enough. If the cast can be squeezed together without wincing or pain, if is overwrapped with fiberglass insuring a tight cast to facilitate proper alignment and healing. I was able to overwrap with fiberglass reinforcing the knees and heels.This gave me an opportunity to work with the material without the danger of putting it on too tightly and navigate ankles and feet. Reinforced knees and heels gives the cast a better chance of staying intact for several weeks in active children who will be crawling or scooting on their heels and buttocks.  I also was able to continue working on applying plaster of paris casts to clubfeet. This requires rolling the plaster snugly and maintaining new position of the foot.

Dr. Frank and the surgical team hard at work (photo credit Mercy Ships)

Skilled hands and mind use by God to bring hope and healing. (Photo credit Mercy Ships)

Dr. Frank loves to teach. I have learned a good amount in just a week. I was able to see a surgery this week. I got to see a good surprise. It was expected to be a large bilateral foot surgery in order to achieve flat feet. Dr. Frank started with the most conservative procedures examining the amount and type of motion achieved with each. The less surgery the better. To everyone's amazement, the child's feet gain significant motion and achieve a good position with to smaller procedures. Dr. Frank decided to stop there. We will continue with the Ponseti procedure to slowly gain more motion. Dr. Frank was pleased we had the luxury to of patience and time to treat this way. If the child needs another surgery later, he will be able to receive it. As always the less cutting, the better especially in growing children.

As I was reflecting on this week, I was struck that miracles were occurring before my eyes. Feet were being moved and flattened, legs being straightened, love being given and received on a two way street (patient to crew and crew to patient), dark eyes starting to transition to light in eyes and smiles. A surgeon stopping earlier than the had planned on surgery because it was best for the patient. People from 4 countries speaking 3 different languages working together as a Rehab team.

Still not sure about all these white people on a big white ship.(Photo credit Mercy Ships)

What a difference a day can make. (Photo Credit Mercy Ships)