Clinic Day 2

Sleep has been an issue so far this trip. After a few hours of restless sleep I actually drank a cup of coffee with breakfast (I do not drink coffee so I knew I was tired).

Emily and I headed to clinic while the students stayed back for the day. The clinic was back to normal and we got going right out of the gait.  In mentorship today my first mentee, Denis, was able to treat two patients. He is an experienced therapist of 8 years who decided to do the residency to improve his manual skills. Most of the therapists work in a hospital setting but this therapist does home visits. It was cool to see that there are other options for income and employment. Denis did great for his first patient really going through a sound examination. The patients symptoms were in the low back region and he had to determine lumbar vs SIJ involvement. Using special tests and palpation we were able to determine the driver of the patients symptoms. Being systematic with assess, treat, and reassess, the therapist was able to gain a stronger understanding of this clinical pattern.

The second student was having her first ever mentorship experience so our emphasis was gaining confidence with patient interaction, working on gainaing a flow for an evaluation, and trying to use assessment to find impairments.  The challenge for this patient was that she had two areas of pain without a clear connection between them. Being the first time treating a patient it was a challenge for the therapist to keep on track.  She was able to get through the whole exam and I think she will learn from this but was not optimal for a first session.  I hope that we can have another session over these two weeks.

After clinic Emily and I had a late lunch with Martin who is one of the mentors in country. Martin has a passion for growth in the profession and improving quality care in Kenya. It was inspiring to see his passion and emphasis on continuing education and clinical reasoning.  I am excited to build a friendship and have more discussion as we have very similar beliefs about thought process and the future of physiotherapy globally.

Day 3 to come!

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.

Sunday arrival in Kenya

We arrived in Ethiopia for a short layover Sunday morning.  This is the first time in Ethiopia since my trip with the Global Citizenship Project at Shenandoah University during my junior year of school.  The smells and culture came rushing back when we landed.  Did not get to order any food but I plan to get some during my stay in Kenya.

Luckily our flights were right on time and we arrived early in Kenya.  It was surprising cold as this is their winter time and it was about 64 degrees and no humidity. Driving from the airport to the city it was filled with a variety of business, buildings, and people.  The disparity in classes is seen clearly along the drive.  We arrived at Grace House where we will stay for the 2 weeks which is very close to KMTC (the university) and KNH (the hospital). Everyone was so nice and welcoming.
After taking a small nap and unpacking, Emily and I explored and went to a local market.  We follow d this up with a meeting with the mentor organizer for the resident students this week.

I am starting to get very excited for this opportunity but worried about how I will treat and move well in a suit. Kenya has British influence and the dress code is very formal. We will see how it goes tomorrow.

I was able to get a workout in before dinner and meeting up with the SU students who did some sightseeing today. We went to the local mall and had a meal with my first local beer. We are all very excited for our first day in clinic!

Travel Day

Excited for this next adventure!
I am headed to Nairobi, Kenya through The Jackson Clinics of Northern Virginia. I had the pleasure of learning from the owner, Richard Jackson, while in PT school and continued a relationship during residency and fellowship training. When he approached me with the opportunity to mentor Kenyan therapists in orthopedic manual therapy I could not contain my excitement.

After a year of planning and preparing the day is finally here to travel to Kenya. Another one of his employees, Emily, and myself will be mentoring 18-20 physiotherapy students for the next two weeks.

To make this experience even better, SUPT Thrive, the student lead medical mission trip group at Shenandoah University will be also on the trip. Four students from the program will be working alongside and mentored by Kenyan practicing physiotherapists. The model for this trip is amazing with Americans mentoring Kenyans and Kenyans mentoring Americans!

We will be traveling for 17 hours and arriving in Kenya on Sunday afternoon.

Looking forward to mentoring, making new friends, exploration, self reflection, and self growth.