Day 6: Clinic Day

Today, the groups split again and Carli, Gopi, Maggie and I headed to the CCH Clinic. This is the outpatient clinic where patients can come if they have a referral from their doctor. The clinic is nice and has many treatment tables with lots of different supplies and some equipment. Not too bad for Haiti.

Today, we saw several patients with a variety if diagnoses, but the main underlying theme seemed to be lots and lots of edema! The students had a lot of time to practice some hands on skills with some retrograde massage. We saw two people who had had a stroke several months ago. We worked with them on restoring motion to their affected side and gait training. One gentleman wasn't using his cane appropriately and we were able to teach him how to walk more safely with it. The students did fabulously today and are working more independently with more confidence. 

After our break for lunch, all of us came back to the clinic. Maggie and Kathryn were able to make a splint for the young boy we saw yesterday who was missing his radial shaft. 

An American pediatric orthopedic surgeon is going to be coming in April so we told them to put this boy on the list for a consult for possible surgery for a rod placement . 

And some more retrograde massage for some more broken wrists and hands!

When the clinic was a little dead, I did some cleaning and organizing of their therapy closet. It is filthy and there are so many supplies, splints, and braces that they don't ever use or even know how to use. It's kinda sad. Gopi was quizzing Claudy our rehab tech on his anatomy. He's so smart and wants to eventually become a PT!

After clinic, we went over to the Sisters of Charity house. This is a sort of respite house run by nuns. The organization itself was originally founded by Mother Teresa. There are beds and beds full of babies, infants, and toddlers that they are taking care of. These children are not orphans as their parents sometimes come to visit. They are just unable to care for them. It's so sad, but not as bad as the Romanian orphanages. These children will interact with you and make eye contact. They are well cared for by the nuns who care very deeply for them. You are unable to take pictures inside, but their faces will forever be burned into my memory. Some of these children are so malnourished they are wasting away. The sisters are trying their best to nurse them back to health. It is just so sad. We are nearing the end of our journey. It has been such a great trip, I will be sad to leave :(

Day 4 & 5

Sunday was our day of rest and relaxation. A couple of us met up on the roof for a devotion and prayer time. The students had been to church the Sunday before and didn't exactly have the energy to sit through another 3 hour service in a language they don't understand. I don't blame them. It was nice getting to know another side of them in that way. Later on we visited the Arts District in Jacmel and got to buy some souvenirs. All the stores were filled with these crazy masks they use during the yearly carnival. 

Scary right? We were able to walk around an art gallery and see some of the local artists at work. One guy told us that he used his hair in his art work (kinda gross). Upstairs were all the studios where the different artists worked. The wall was broken in places so the ocean could be seen outside. You could hear the waves the ocean was so close. It was beautiful.

The artist told us he also ran an art school and taught painting, drawing, and photography. 

We ended the day at one if the nearby beaches. It was beautiful. There were people playing soccer on the beach, the water was warm, and music was playing. It was perfect... Except for people coming up to you constantly asking if you wanted to buy things and not leaving. Oh well, we had fun anyway!

 

This morning, we split up in groups again and I led a group of three students to Pazapa again. There were more kids there this morning than the last time we went.

They have a huge storage room with donated equipment and I saw this guy hanging out in the corner (Lisa, can we work on getting one with an actual seat :) )

We got a chance to try some new techniques today. We did some sensory integration activities with our one little girl who is developmentally delayed.

We did some chest PT on a little boy with chest congestion down into his lungs.

We educated the caregivers again on things they could do at home to help. One thing that particularly pains me is the way that all of them feed these children. Hardly any of the kids have mature chewing or swallowing patterns. Some of them don't chew at all and their parents force the food in. There heads are fully extended during feeding and sometimes they are reclined. They only have rice and beans and sometimes crackers, cookies, or Cheetos to feed them with water or milk to drink. There is no puréed food or thickened liquids. I didn't know how to help this and it was frustrating as they don't have the means or resources to get appropriate food. The students and I taught them the importance of sitting them upright and giving them small bites and sips. Speech and occupational therapists are greatly needed here. 

After that we went to the clinic and treated a couple patients there. There was a little boy with a total SC joint separation. Another lady had brought in X-rays of her family member and asked if we could help. We looked over the X-rays and noticed a complete fracture below the head of the femur. We told her to take the lady to a physician. After an hour or so, the clinic closed and we went to another building and saw more people in an empty room with some folding chairs. One man had had ankle surgery months ago and was still having pain. His ankle was giant and swollen with very limited motion. We taught him some exercises to improve his range and increase his weight through the joint in standing. Another boy we saw had a deformity of this hand. His dad stated he had surgery a while back and now his hand is crooked. Well turns out , we couldn't feel a whole intact radius. The surgeons had removed the radial shaft, only leaving the distal and proximal ends. Wild stuff! Only in Haiti. 

The days are winding down and the students are still trucking. They are doing a great job in taking on so much information in such an extremely difficult and emotionally draining environment. I'm proud of them! 

Day 3: Outreach Day

Saturday was supposed to be a day to relax for the students, but we were offered a chance to go on some home visits with an outreach program through Pazapa. This outreach program seeks out children in the rural villages around Jacmel who have disabilities and try to meet their need. These families have no way to travel to Jacmel where Pazapa is, so Pazapa sends out their workers to work with these kids once a month. Jeff, Carli, Maggie, Katie, and I all went together today. It took us an hour to drive to the village up in the mountains, after which we had to hike about 10-15 minutes after we got out of the truck as there was no road. We rode for the hour, standing in the back of a pick up truck up rocky roads, trying not to fall down, and we picked up a baby goat along the way which we had to deliver to a family later on. The poor goat was having trouble balancing too and kept bleeting to the other goats we passed for help. When we got to the first house, we were greeted by the family of the little girl we were there to see. She was being cared for by her uncle and some other family as her birth mother we were told had mental problems and could not care for her. They brought out a bamboo mat for us to work on, and laid it on the ground in the shade of the palm trees. They changed the little girl's dingy dirty clothes into a sweet little dress (which was probably the best thing they owned) and put some underwear on her as she wasn't wearing any. The little girl was unsure of us at first, but started warming up to us as time went on. Her impairments were stroke-like in which she had a weak side which she didn't use and facial weakness which caused her to have difficulty with drinking and eating. She didn't speak. 

We started our assessment and saw that she had some movement of her affected leg, but no movement in her arm. We had brought some coban and decided to play around with some CIMT (constraint induced movement therapy) where we wrapped her strong hand up, to make her use her weak hand to play. After about 5 minutes of hand over hand play with her weak side, she started activating muscles in her shoulder and started trying to reach towards stickers and toys. It was awesome!

Another little boy who was at the home who was probably a little over 1 year old kept consoling her when she would cry. He didn't have any pants on and was so dirty. It was so sad, but he was so cute.

Jeff and I assessed her walking and standing abilities and noticed she was trying to initiate stepping on her weak side but was unable to bring her leg through due to foot drop. We added a wrap to her leg to assist her with holding her foot up, and she was able to advance her leg and step on her own. It was awesome! We taught her uncle and the rest of her family how to work with her on using her weak side and how to help her stand and walk with her as much as possible. The students got to do so much handling and practice new techniques. It was great.

Next, we hiked a little more and came to our next family. This little girl was five years old and appeared to have spastic cerebral palsy. She did not walk, talk, stand, or feed herself. All four of her limbs were affected. She was able to sit on her own and move herself around by scooting on her bottom. She was amazingly doing quite well for never having received any medical or therapeutic intervention. Her father says he just tries to make her walk and stand, moves her legs and arms, and helps her move her arm to feed herself. In the picture below, you can see how her father helps her move her legs forward with his toes!

We educated the family in very simple terms about the injury to her brain being the cause of her problems and told them how they could help her by keeping her mobile. We taught them range of motion and stretches to maintain the motion she already had in order to prevent muscle contractures. 

We also taught the family on how to better position her body in a chair to feed her as she had very poor core and head control as well as strengthening exercises for her trunk. The family was very happy and glad we came to see them. People from the outreach program at Pazapa will continue to check in on them and implement our suggestions.

After we saw our patients, we went to deliver our goat friend (who we named Billy) to a family with a deaf child. Pepe who was with us all day, works at Pazapa and teaches the children who are hearing impaired. He was going to try to talk to the child's family into allowing him to move to Jacmel to come receive an education and learn sign language at Pazapa. This 8 year old boy had been living in this remote village with no means of communicating his whole life. If his parents agreed, he would go live with another family while he went to school. His parents agreed after talking with Pepe and the little boy will start attending school starting in September in Jacmel, which is over an hour away from their village. Pepe is the only sign language teacher in Jacmel. This will be great for this little boy to give him a future and a way to communicate in his world. We came home exhausted, but happy. I'm so proud of all of the students for being so flexible and ready and willing to take on anything. This is truly turning out to be such a life changing trip. 

Day 2: Pazapa

Today was our first treatment session at a school for children with special needs called Pazapa. Pazapa has a program where kids in the town can come with their caregivers to the clinic to get treatment from a PT or a therapy aide. The caregiver or parents stays with them while they are there and they learn better ways to help them at home. Today, myself along with Leslie, the other OT professor, led one team of students (Jeff-PT and Katie- OT) while Kathryn and Karen led the other team made up of Carli (OT), Maggie (OT), and Gopi (PT). Pazapa was amazing. The kids were so sweet and their caregivers were awesome to work with. One of the little girls we determined was developmentally delayed, two others had CP, and the last little girl had severe scoliosis. We explained to each caregiver as best we could in simple terms what caused their child to have these impairments, then taught them activities they could do at home to help them. 

We circled up all the moms with their kids and had a time for handling and instruction on stretching, standing, positioning, and handing. It was awesome. Pazapa had a storage container full of therapy equipment that was untouched because no one knew how to use it or what it was (tumble forms, Amtryke, standing frame, etc...). We were able to get one of the little guys into the stander and work on feeding with him to adapt the equipment to allow him to feed himself. It was awesome! Most of these children have a lot of oral motor and swallowing problems, but since food is scarse, people usually feed them whatever they have (which is normally always rice and beans). Many of them choke and aspirate on the food. Jeff and Katie got to see such a wide range of impairments and got to practice lots of handling with the kiddos. There was one little girl they had warned me about that hated everyone and didn't smile. They pointed her out and right when I walked up and started talking to her, she started smiling. The translator said it was because I was acting like a child... Sounds about right. 

Clinic ended at noon, and that afternoon we all went on a hike to Bassin Blue, a waterfall up in the mountains. It was beautiful! The water was so refreshing to swim in after being so hot on the hike.

That night we went to a hotel on the water for dinner. Again, beautiful! We bought souvenirs and ate Americanized food. It was glorious. And this cute little hammock was just in the most perfect spot. I'm having so much fun :)

We made it!- Day 1

So after a long travel day and some delays in Miami (a screw came loose on the plane), we finally made it into Port Au Prince. Kathryn, the OT professor, and I had met up in the Miami airport and got to fly together to Haiti. When we arrived, there was the usual madness of luggage being thrown everywhere and people trying to help you with your bags despite telling them no. We met up with our driver Johnson who drove us to the smaller airport to take a small flight to Jacmel. The plane we flew on looked like a remote control airplane it was so small. I tried not to think about it so I wouldn't freak out. It turned out to be quite amazing and was such a beautiful view. Here are some pictures from the air...

After we landed, we were taken to the Isaiah 61 house where we will be staying. I got to see Karen again and catch up with her and meet all the students I will be working with. The students have been here for a week already and are having a great time. At night, we met on the roof to hear a debrief about some different patients they have been seeing. The students have been having to perform evaluations and then make assessments and treatment plans up for these different patients. While they were presenting, the bats from the near by fruit trees kept swooping dangerously close to their heads. We tried to ignore them. The students are so eager to help and learn! Another lady came to speak with us from the organization Beyond Borders. Their mission is to help abused women and to change the mindset of these women and their partners that women have worth and abuse is not the answer. I found it so awesome that she was taking the approach of trying to educate the men on how to change their perception. She employs Haitians to teach the classes as they are more likely to listen and change if someone from their culture educates them rather than an American. So great! Tomorrow we will be working in a special needs school! I can't wait :)))

Haiti: Round 2!

Well, it was a little unexpected, but a trip to Haiti fell into my lap and I couldn't say no! Everything worked out perfectly and I was able to take time off work quickly thanks to my awesome managers! This time I will be traveling with my alma mater Shenandoah University and am getting the opportunity to take on a new role as a clinical instructor to two PT students. I am super excited for this opportunity and can't wait to meet them both. I also get to see one of my favorite SU professors Dr. Karen Abraham who I can't wait to catch up with! I was left feeling a little unprepared for the trip as I wasn't involved in all the planning and organization of the trip. It felt great not to have all the responsibility and I was just able to enjoy the experience this time. I am looking forward to the new city Jacmel we will be working in. It too is on the south coast of Haiti, just like Les Cayes, but is a little farther east. And the best news of all, when we arrive in Port Au Prince... No 8 hour road trip with road blocks and demonstrations!! We are taking a smaller plane right into Jacmel. We will be working with the organization Community Coalition for Haiti and will be staying in their dorms. An Occupational Therapy professor from SU will also be there with three of her students. All of these students will be receiving fieldwork/internship credit for their time spent in the clinic. What a great program SU has provided for the students! So, I decided to keep blogging as I enjoy looking back and reminiscing on life changing moments (and it keeps my family from worrying too much). I would appreciate your prayers and thoughts over the next week on allowing us to impact the people of Jacmel in ways that are sustainable and life changing. Thanks friends!! Now, if only this layover was shorter... 

Morning sunrise on the flight from Jacksonville to Miami

"Rejoice always, pray continually, give thanks in all circumstances; for this is God's will for you in Christ Jesus." 

1 Thessalonians 5:16-18