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Clinic Day 5: Los Cuatros Amigos

Today we got a down and dirty look at what a typical day in rehab is like in Zacapa. We spent the day at a H.I.M. Rehab center in Zacapa (right next door to ROMP) and saw quite a few patients who had been seen prior at this clinic, which meant that we got the chance to progress treatment for many of our patients. We worked alongside our Guatemalan PT friend, Estin, and were super blessed to have Angel with us again, acting as interpreter extraordinaire. Today was especially interesting because we had the opportunity to co-treat with Speech & Language Pathologists, PT, and P&O. Getting to combine our treatment sessions was eye opening for both groups as we each learned more about what the other profession does during treatment & evaluation. Combining the three specialties (plus the interpreter- hence the 4 amigos) allowed us to not only learn from each other, but build more efficient treatment for our kiddos who benefit from shorter sessions. It also made for more creative sessions as we intermingled all three specialities into one giant rehabilitation machine. We worked very well together and were able to combine our individual treatment goals smoothly. One of the best examples of this was a little boy who came in with extreme hearing loss caused by infection and seizure, who needed SMOs, needed coordination and balance training, and speech was able make recommendations for not only communication but oral hygiene as well.

Megan and Becca had an atypical experience today that probably would not have happened in the US. A 73 year old women came in with a high humeral fracture in her upper arm with a nonunion, which means her bones were not fused together. This happened a year ago after she had a car accident and she had been living in a sling ever since. They made some sort of fracture brace using an off-the-shelf ankle brace, a heat gun, and the grinder next door. It wasn’t glamorous (or something they would ever do in the states) but the patient was happy so it worked out. Megan learned a ton today about early forms of communication in patients with developmental delays from our speech counterparts such as eye gaze, pointing, and the ability to make choices. Becca felt very confident in her skills today when a patient came in with a very specific prescription from the doctor for a KAFO, when upon evaluation an articulated AFO (with a space boot pattern!) was more functional and assisted rehabilitation better.  

Our PTs had a wonderful day as well, with Diego even getting to dance with one of his patients! He is verrrrrrry popular with the ladies (especially the littlest ones!) His magic hands helped get rid of a woman’s headache and again he proved himself to be the resident baby whisperer, calming the scared baby with hearing loss just by picking him up. His last patient of the day came in complaining of extreme knee pain with spinal cord injury after gunshot wounds. He had been seen by many doctors, specialists, and rehab professionals for his pain to no avail. His mysterious pain proved to be a challenge and showed us that while we may question ourselves as students, there will be times when even the professionals are stumped and it’s okay to not have all the answers. Jason really enjoyed working with his patients with Cerebral Palsy today, coming full circle by starting and ending with two lovely patients. Jason and Ashley were also the TA crew today (transverse abdominus), teaching 3 different patients how to activate their TAs. One patient in particular struggles with this, finding the only way to contract these muscles was with laughter. She left with homework to watch a funny movie because laughing was the best way to activate her abdominals. Ashley also learned a lot about rehabbing clavicular fractures, working with a patient who had had two external screws put into his shoulder to help stabilize the clavicle- something we have never seen before.  

Overall, the best part of our day was getting to co-treat together with speech, as it made for a huge learning opportunity for us. We were very impressed by the fluidity with which it occurred! Tomorrow we will be back at the nutrition center for our last day of treatment.

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