Clinic Day 1

After a restless night sleep I awoke to the sounds of the Nairobi city.  All night I kept thinking about how mentorship was going to be, what the hospital would look like, and how the Kenyan therapists would view me.

After getting dressed in my suit and lab coat (which I have never work to treat patients), I practiced trying to do some manual techniques making sure I would not rip my jacket later that day. Once confident, I headed down to breakfast which was amazing. Buffet style English breakfast with everything included.  The typical Kenyan dishes were similar to Ethiopian and Ghanaian dishes, but the tea and breakfast are 100% British influence!

Once the group was ready we were out the door by 7:30 am for a short drive to KMTC (Kenya Medical Trainng College). The hospital located on the same  campus is a 1,000 bed hospital. The head of the rehabilitation unit at KNH (Kenyatta National Hospotal) told us this was the largest hospital in what he called “black africa” meaning south of Egypt and north of South Africa. It was amazing to see the size and function of such a large hospital.

 

 

Once on campus we were given a tour and got to meet many of the physiotherapist and heads of many departments.

 

 

We were supposed to start clinic at 8:00 am but once a handful of patients were present. The staff explained to us that typically the waiting room is overflowing with patients in the morning making this atypical. We found out a short time later that the entire staff of the hospital went on strike for wages. It was estimated that >4,000 men and women protested the unfair wages demanding better pay.  We heard a man on the megaphone talking at one point but could not make out the words.

After waiting for the management to determine our plan we were finally able to start our days in the clinic. The students worked with the Kenyan therapists treating patients while Emily and I started mentoring. Our first resident was Isaac who has been practicing as a physio for many years before joining the residency program. During this patient interaction there were many skills that you could tell he had developed overtime that were strong. The emphasis treating this male patient with low back pain was improving his systematic approach to subjective questioning, using questioning to help rule out red flags and origin of symptoms, as well as creating a systematic objective examination to make sure he examines all possible areas of involvement for treatment. Questioning and reflection in-action were great ways to help improve his treatment for this patient. The patient walked in with many concerns and limited movement, but walked out educated, less fearful of movement, and with less pain. After the mentorship the student expressed his beliefs on the experience and mentioned how much he felt he learned in the session. For myself and Emily this was a great boost of confidence for the week. 

One more mentor session occurred before lunch. I had the pleasure of working with Janet who was in her first mentorship experience ever. She went directly from receiving her diploma in physiotherapy to the residency without any work experience. She was extremely nervous so I worked to ease her mind. During the evaluation I worked along side her to build her confidence and help keep a steady flow. She was able to evaluate and treat a young male who was a few months post a lower leg fracture and Tibialis Posterior tendon repair. His biggest concern was walking as he thought he could put pressure and break the metal plate in his leg. She needed many cues during the session but she was able to perform all of the tests and measures as well as treatment. This patient came in using two crutches afraid to put his foot down and left with increased ankle dorsiflexion and heel to toe walking using the crutches. Combining manual therapy, patient education about his plate, and gait training was used to treat the patient, but the biggest impact was how excited Janet looked once the patient left and she had done her first evaluation!

We took a break to have lunch at the local cafeteria which was a stand alone small building on campus. The cafeteria had local dishes including Ugali (maze flour) and beef stew which was amazing. You cannot beat the price of $2.50 a meal either!

     

After enjoying our food we did one more mentoring session. I was paired with Peace who has been a physiotherapist for 8 years. She was also looking to improve her skills when she signed up for the manual therapy residency. She has a phenomenal subjective examination. She was able to gather everything needed for the middle aged gentleman with right lower leg symptoms who was one year after a severe motorcycle accident causing many fractures and skin grafting needed for his injuries. He is now walking only about 1/2 kilometers with one crutch. Peace improved her objective skills with using assessment of both limbs to help find impairments to treat. She used her past experience to make assumptions instead of treating this patient specifically. I had been making the same errors during fellowship and used the techniques my mentors used with me to teach her. It was very surreal to see the process coming full circle. 

Today was 3/3 for mentor experience and I am looking forward to many more days to come. 

After clinic I was able to workout before having the daily afternoon tea. We were given a tour of the local area around Grace House and learned of some great places to try during our next two weeks. We even learned of a place where Mark Zuckerberg has come. Tonight we had a great meal at a place that served two for one burgers.  Can't pass up on a special.

Reflection on the day rounded out the night and Day 2 awaits tomorrow.