We started today with Devotions at the hospital, which is the way that every work day begins here at Chidamoyo. This part of the day is most obvious reminder that we are at a Christian hospital. Following a prayer in Shona, Major, the hospital administrator, gave a sermon of sorts based on a bible passage. This was followed by a lovely formal welcome of our group by the hospital staff. Interspersed were hymns sung in Shona which were beautiful enough to make anyone a believer. The staff who lead the hymns are very musically talented, using syncopated clapping and harmonies while singing.
Following Devotions, we gave an in-service to the nursing staff on simple questions they can ask parents during well-child checks and vaccination visits to better screen for developmental delays. This topic was requested by Mr. Kamuhka, who feels that developmental issues are not being caught as early as they could be.
As we walked from the courtyard where the in-service took place to the rehab offices, we noticed a long line of families waiting outside the door. Apparently, word had spread about the “Cerebral Palsy Clinic” organized by Mr. Kamuhka. We broke up into teams of 3 (1 CI and 2 students) and quickly set up informal examination areas on the floor of the office with yoga mats and various toys. Over the course of the day we probably saw close to 30 patients collectively. Thankfully we had great assistance from the village health workers, who helped us with interpreting. Mr. Kamuhka also helped to facilitate our brief examinations and interventions as most of the patients were familiar to him. As it happened the “CP” clinic ended up being more a general pediatric clinic and we saw kids with a variety of disabilities.
Some memorable patients for the day included:
- Nicole, Brian & Lisa: A mom from the area came to the clinic reporting that her three-year-old son was experiencing pain in his groin area when carried on her back in the zambia. During the evaluation, the mom removed his pants, so we could take a closer look. Upon examination, it turned out that he had a very enlarged scrotum, which was causing him pain. Since this is out of our scope, we decided to provide some foam for better positioning to offload the pressure to his groin area, as well as to refer him to the doctors here. We were thinking it could be some sort of infection or a hydrocele. Brighton said it could be a hernia and we did not realize that a hernia could cause it, but he was correct as was confirmed by the doctors. Since it is a hernia, it cannot be aspirated, and he was scheduled for surgery in September, which is when the specialized surgeon who comes every other month will be here.
- Elisa, Ben & Sara: A seven-year-old girl with severe knee flexion contractures on both legs and club feet who we casted for splints to help gently stretch her legs at night. While she is unable to walk due to her deformities, she can get around by crawling on her knees. Her mother told us that her knees are often scraped and bruised at the end of the day so we jerry-rigged some knee pads out of sleeves that are typically used for arm braces. Due to her daughter’s mobility issues, her mother continues to carry her on her back when travelling long distances. We inquired about getting her a wheelchair, but because the family lives in a very rural area with rough dirt roads, this would not be a feasible form of mobility.
- Ellee, Sam & Kendra: An adorable 8-month-old baby boy with a right brachial plexus injury that took place during birth due to obstruction. It presented as a lower injury (C8/T1) as his should motions/muscles were in-tact. His hand intrinsic were severely impacted so his tiny fingers were in a perpetual loose fist and his palmar surface was hypersensitive. Due to the lack of finger extension, he utilized tenodesis to gain slight openings for grasp. We worked on gripping and maneuvering items of varying sizes/shapes, weight bearing (with mom’s assist) on his right hand, exposing the palm to various textures to decrease its hypersensitivity, and encouraging use of the right side by gently restraining the left during certain tasks. The mother was very receptive to this and was excited for all these activities for her home program.
- Ben, Elisa, Nicole, & Lisa: A 70 year old female who experienced a left CVA 10 hours ago due to defaulting on her blood pressure medications (which we have been told is a common problem here). It was the first time we had experienced such a ‘fresh’ CVA and were curious to see what we would find. With the help of Mr. Kamuhka, we were able to communicate with her and the several family members there with her. We demonstrated to Mr. Kamuhka the ‘neuro acute care’ screen we have learned in school to assess her impairments. Since she had a left CVA, she presented with R sided weakness in upper and lower extremities, very low tone, right sided neglect, inability to speak, and, possibly, mild issues with comprehension. We were able to sit her up and perform some lateral weight shifting, but she required 2-3 person assist, so we did not try to stand her. We ended the session by showing her family members two exercises to work on with her during the day.
Some fun facts we learned today:
1. Regarding rabies…
--When a person (or animal) contracts rabies, they are hydrophobic, meaning they are
severely afraid of water
--You can start showing signs of rabies up to 10 years after contracting it
--An animal with rabies will only live for about 2 weeks after contracting the infection
initially
2. Most Zimbabweans are farmers and only 10% of the population has a job