We had a whirlwind of a day today and barely had time to eat! In the morning after devotionals, we saw a couple of patients. One was a 21-year-old young man who had suffered a deep wound on his foot back in March due to a rock slide that escalated into osteomyelitis. The barriers to care in Zimbabwe are great (especially geographic and fiscal) so periods of time between visits may be extended. Additionally, adherence to certain precautionary protocols are low as people will work through injuries out of necessity. Due to this, soft tissue injuries or even certain wounds are treated with casting so that the area is protected and forcibly immobilized to allow healing. So, by the time we saw him today he was a few weeks after removal of his cast and was partial weightbearing and ambulating with axillary crutches. He reported that he was still experiencing pain and swelling. After evaluation, we determined that his heavy scarring was inhibiting his ankle range of motion and blocking the swelling within the joint capsule. We worked with Mr. Kamukha to come up with a plan for him that included scar tissue massage, range of motion, ankle stretching, and weightbearing. It was funny because as Lisa and Nicole treated him, he was trying to ‘sneak’ a picture of us ‘white people,’ which was comical and also made us feel better about taking pictures of them.
Midday, we met with over twenty village health workers from the surrounding areas and a gave talk. These incredible individuals are point people in their communities for health concerns and both hold individuals accountable and assist them in getting to their appointments or accessing medication refills in time. They serve as resources and advocates for their villages and intimately know the cultural, environmental, and personal contextual factors of their communities. Due to this, they have been vitally important to our team as we generate solutions to the concerns our patients present.
Our lecture focused on recognizing delayed developmental milestones earlier in a child’s life and referring them to the hospital to receive care for earlier interventions and therefore better outcomes. We passed out laminated development charts with pictures and talked them through the process of tracking the development of children in their village and referring kids who fall outside of these bands of typical to Chidamoyo earlier in their lives. Mr. Kamukha brought in several children for the health workers to practice with and they were able to immediately apply the information we had just passed on.
Additionally, Mr. Miga, a leader of the village health workers, researched Cerebral Palsy this weekend and gave a brief overview on how to recognize this condition earlier as well as risk factors to support this population of kids in getting care earlier as well. He used the text “Disabled Village Children” (of which we brought five copies) as a resource. Mr. Miga has instated a book club using this text with the other village health workers. Each will read and present on a chapter each month to improve their ability to serve individuals with disabilities in their villages. We were incredibly pleased with the outcome of this collaboration and look forward to working with the village health workers later this week as we visit rural villages for home visits. On a separate note, we have had the pleasure to work with Mr. Miga everyday and are inspired by his motivation and dedication to his community and their health. He has been an essential component of our being able to communicate to families and the other village health workers and in ensuring the sustainability of our work here. We are so thankful to have him!!
We worked through lunch finishing up the outpatients who were waiting for us during our talk. Two of these were relatively recent CVAs and for the third time this trip the group sent a patient home with a dollar store jump rope to use as a pulley for active assisted range of motion for the affected limb! We finished the day in the hospital seeing inpatients. The most notable was a young man who underwent a surgery to manipulate a tibial-fibular fracture that went untreated for 2 months due to his family’s religious beliefs. The untreated fracture did not heal in the correct position and he finally sought care at Chidamoyo. However, given how much time has passed, the only treatment that Chidamoyo could offer was to rebreak the bones at the fracture site, put the leg on traction, and hope that it will heal in the right position. The doctor mentioned that the patient’s best outcome would be to get an ORIF with a rod placement in Harare, but the patient refused those service due to money and religious beliefs.
After a long day, we went for our daily evening walk around the community, before another delicious dinner and bedtime.