Surgical 2

(This post was written on Saturday, but was postponed because of the need of photos)

Our first week of practical came and went. And we are sitting here with many impressions to process during our free time this weekend. 

First of all you have to understand that this is in the middle of rural Tanzania, it has to be VERY serious even to consider taking the long travel into the hospital. When it’s finally serious enough to go to the hospital, they have a journey that might take several days, ahead of them. So by the time they’ve reached the hospital... it is a catastrophe. 

Henrik and I have both been in the ward called surgical 2 this week. The patient’s problems vary a bit, but the thought is that the patients in this ward are supposed to have had went through surgical procedures, or are waiting for their operations. The reasoning for many of the patients problems are repeated in several cases. For instance: fell out of a tree, got kicked by a cow, was beaten (axe, machete, husband, mother in law) or run over by car. The main group of patients have fractures, and here they use traction to treat them, which means they might be laying in the same bed, not being able to move for three months. So our job is to mobilize the patients joints as well as possible, and apply active movements with resistance for whichever body parts aren’t in traction as much as we can. 

(a traction device for a femur fracture, at the end of the rope are weights to pull the leg)

Whether traction is the best option for treatment is a whole different story. It is a huge risk to create open wounds here, because of infection. And a traction device needs to be thoroughly cleaned often. You might ask: why should this be a problem? Well, then we are moving over to the issue of African culture, which is a whole different chapter.

We have been learning Swahili phrases to help us with our physio practise (because the patients here most definitely do not speak English), so by the end of this week both Henrik and I felt that we were able to complete treatment without having to constantly ask for help. Which was a GOOD feeling. 

(Family members + Henrik. It is the family member's duty to feed, wash and clean the patients. So if you don't have any family around you'll have a big problem)

One of the strangest things I saw this week was an open fracture. The patients Tibia and Fibula were completely fractured, it was an open wound, so we literally saw the bones stick up in the air. Which means the only thing attaching his foot to the rest of his body was soft tissue, posterior. It was the craziest thing I had ever seen!! And even crazier when the patient was still able to plantar flex his toes... After the doctor removed his dressing so the wound and fracture were completely open, he disappeared... So I was given the task to keep the flyes away from the wound while my mentor went to look for a nurse to dress it again. I wasn’t sure if I should cry or laugh, so I simply stood and waved the flyes away instead. 

It would be typical to write about the challenges of working as a physio therapist in an African hospital. And typically I would say “African time”, all the waiting. But personally it doesn’t feel like waiting, because we are constantly busy. It’s more that we have to spend our time doing other things, like looking for a wheelchair to transport a patient, or find food for the patients so that they’ll be able to exercise. So we spend our time doing other tasks, that shouldn’t be necessary, or should be somebody else's responsibility, instead of doing physio therapy. 

I hope you have gotten a slight impression of how our first week was!

- Shandell