Today happened to be Dr. Mudzingwa’s birthday, one of the two doctors on staff at Chidamoyo Christian Hospital. He was nice enough to offer Sam, Ben, and Lisa to follow him on his morning rounds to see patients at the pediatric, maternal, adult, TB male, and female wards. We saw the whole spectrum from a 2-year-old who suffered from significant bee stings to a 70-year-old only 2 days post CVA. We also witnessed a patient who had a severe displaced fracture of the tibia and fibula that they suffered two months ago and did not seek medical treatment due to religious reasons. This patient had to be taken to the hospital at the suggestion of her aunt given the severity of the fracture. We also saw a patient with kryptomenigitis secondary to HIV, which was one of the most common form of meningitis and has poor prognostic outcomes. On a lighter note, we ended the rounds to check in on three newborns and their mothers, all who presented in good health and positive vibes.
While Sam, Ben, and Lisa were at rounds, Elisa, Ellee, Brian, Nicole, Kendra, and Sara were able to work with a 14-year-old boy with athetoid CP. It was a special moment for Kendra and Sara who had worked with him the first time they came to Chidamoyo, about 4 years ago! At the time they were working with his grandma on what she could do to help him stand and walk with support. Today, we were able to continue work on walking with him and educated grandma on how she could try to fit it in to their daily routine. Given his athetoid condition, he is currently a household ambulator and the grandma carries him out in the community. Although he may be small for a 14-year-old boy, he is still difficult to carry so, with Brighton’s help, we were able to fit one of the wheelchairs to him. Although it is not the perfect fit, we were able to enhance the fit by adding foam rolls on either side of him and wrapping a zambia around his lap and through the seatback to function as a seatbelt. In a kiddo with athetoid CP, all of the muscles in their arms and legs are overworking so that when they are trying to produce one movement, everything is contracting more or less at the same time leading to a dyskinesia. So even in sitting, when he is making the effort to sit up by himself, it is very hard to maintain his balance because he is unable to keep his legs and arms still. Given this, although the wheelchair may not be the perfect fit, It is sufficient enough that he can be relaxed and feel at eased in his positioning AND grandma doesn’t have to carry him around the community.
Brian, Ben, and Lisa had a unique experience working with a patient 2 days post-CVA who was being discharged today (the same patient that Elisa, Ben, Nicole & Lisa had previously seen). Brian and Ben had the responsibility to educate the family how to roll them in bed, to get them to long sitting, to range their arms and legs, and to communicate on the right side to counter the right sided hemi-neglect. But there were some very interesting barriers: the patient was not going to have a wheelchair, their bed was going to be on the ground, the patient was non-communicative, and they were unable to move in bed, sit, or stand independently. This provided a valuable perspective on the differences of how a patient with this presentation is treated in the States and in Zimbabwe. In the States, they would have all the resources necessary to facilitate a speedy recovery like medications and equipment to help with mobility, feeding, and using the restroom. But in Chidamoyo, the patient was not on medications, they had no lifts, and there was not even a bedside chair to promote sitting activity. We had to educate the family how to roll in bed and come to long sitting in bed since, realistically, that is where the patient was going to be and given the limited resources, it was probably the best approach to promote compliance and functional recovery. Afterwards, the family expressed how fortunate they were that we worked with them to help their loved one who suffered a CVA.
Sam, Ellee, Kendra, and Sara checked back in with the little boy, Tafadzwa, in the inpatient ward who had epilepsy and suffered severe burns on both of his feet. His home cooking fire triggered a seizure and caused his burns. Together, the group worked on modifying a pair of shoes donated by Kendra’s daughter to fit Tafadzwa’s large dressings covering his healing skin grafts. They also fashioned and inserted heel lifts made from foam scraps to accommodate his plantar flexion contractures. Tafadzwa LOVED the shoes and was so excited to wear them. We taught his mother how to safely place the shoes over his healing burns and we were able to get him to take his first (modified) independent steps in TWO months using a four wheeled walker. By the end of the session he was walking independently and seemed to really enjoy being active again. It was one of the patient scenarios that had the best possible outcome and we were all so excited to be a part of it!
Other than the day being Dr. Mudzingwa’s birthday, the day was marked by Elisa, Sam, Ellee, Nicole, and Lisa constantly checking in to the delivery room to observe a child be born. After waiting all day, they finally were able to witness the birth of a baby boy around 4 pm. Although he was 4 weeks premature, he was very healthy. They were most struck by the fact that the mother labored stoically—not making a single sound during the whole process. They were also impressed that the nurse delivering the baby, Eunice, kept her white uniform pristine throughout the whole process!