Sunday was beach day. For our last weekend here, we had made plans with Chris to visit a beach in Entebbe. Coincidentally, the UW med students had also decided to spend the day at the beach for their last day in Uganda before heading off to the airport. So we joined forces and bussed to a private beach about an hour from Kampala. The first thing we noticed was that any of the Ugandans not going in the water wore fairly nice clothes to the beach, like they do pretty much anywhere else they go. The beach wasn't bad, but was clearly overshadowed by the tourist-style nature of the private hotels that own sections of the beach. At Imperial Beach Resort, the "beach" includes at least one restaurant, a carnival, and a massive dance floor with a DJ playing all day. Since stagnant water poses yet another threat to us visitors, we spent most of the time tossing a frisbee on the beach, which caught the curiosity of any nearby Ugandans, and taking jumping pictures with Doreen. When I say taking jumping pictures with Doreen, I mean somebody there introduced her to the concept and she wasn't satisfied until she had taken a dozen jumping pictures with everybody there. It reminded me of the time my freshman floor-mate from Hawaii saw snow for the first time.
Monday through Thursday involved little other than COMBRA, which stands for Community-Based Rehabilitation Association. This is an organization located about 30 minutes from Makerere University, in the town of Seeta, which sends volunteers out to villages to help individuals with disabilities learn to compensate for their physical or functional shortcomings and adapt to their environments. The craziest part is that these volunteers have to pay a sort of tuition to be educated by COMBRA, after which they go to a village and work for free. In a place where money and opportunities are scarce, it is barely conceivable that people can do this.
Monday was basically an orientation, or rather a second orientation, because our first one a few Fridays ago turned out to be a 4 hour lecture on the definition of community-based rehab by Barbara, a woman with no shortage of words. Anyway on this second orientation we discovered that COMBRA vastly surpasses Mulago Hospital as far as patient documentation is concerned. We were introduced to the forms used in which volunteers go door-to-door in each village of each parish of each sub-county of each county of each district to find exactly who has a disability, as well as what kind, what the cause was, etc. The detail is phenomenal.
Tuesday we hit the road. With one year of PT education under our belts and zero experience in home health treatment and assessments, I think we all felt reassured that we would be paired up together and given an interpreter/volunteer for each of our home visits, which is why we are all blatantly terrified on Tuesday morning when William, the COMBRA employee in charge of our experience, informed us that we would each be left at a separate house individually, for a period of about 6 hours. To be honest, I figure that without the supervision of a therapist or the guidance of a COMBRA volunteer or interpreter, I could have lasted maybe 30 minutes on my own. Fortunately Karen, our UW-PT professor chaperoning us on this whole trip, talked William into letting us pair up and only staying for 1-2 hours at each place, insisting we would have nothing to do for a 6 hour stint at each house, but this not before Brett had been dropped off and left at the first house. Fortunately Brett can handle adverse situations and he managed just fine.
I was paired up with Allyssia, and our patient was Emmanuel, a 4.5 year old boy with a form of cerebral palsy induced by an infantile episode of malaria. Emmanuel had surprisingly good range of motion and as of March had learned the ability to roll from supine to prone, but with poor vision, limited responsiveness, and dystonia, he was unable to perform any activities of daily living (bathing, feeding, hygiene) independently. Our time there along with our interpreter Gertrude, a recent graduate from COMBRA with a heart of gold, was mostly spent taking the patient's history and testing range of motion and spasticity as well as assessing his recently built CP chair. After lunch, we all regrouped and saw 2 more patients. Along with Anna, Ryan, and Karen, I visited Onesim, a 20 year old boy with periodic convulsions and significant knee and hip flexion contractures who spends all day every day completely alone inside a dark and smoke-filled hut, unable to feed himself or control his bowels or bladder, while his mother works gathering tea leaves on a bordering estate. This patient encounter involved little more than recording a patient history, as realistically there was little we could do for his body or his or his mother's living conditions. Like much of what we've seen so far in Uganda, it was heartbreaking.
Wednesday morning was spent reviewing the patient cases we had all gathered from Tuesday, after which we returned to selected patient houses to take measurements collect 2 CP chairs that needed modification. Thursday was workshop day. COMBRA has a workshop where they build devices such as crutches, puzzles, standers, chairs, and various toys for the individuals they assess who can afford such devices. We spent the morning sawing and hammering our way to improve the two chairs we had collected on Wednesday, while Anna built a puzzle for 2 cognitively-delayed patients she and Ryan had visited on Tuesday. After doing what felt like our minimal best, we returned to the patient's houses a final time to deliver our goods. We also made a few quick stops at a school for cognitively challenged or orphaned individuals, most of whom are apparently dropped off there after being found abandoned on roadsides, and a school where Gertrude works for deaf, hard of hearing, and mentally disabled children. Both of these visits were highly inspirational and discouraging as far as the standards and conditions we witnessed there.
Free from the loose and inconsistent schedule of our clinical internship, Friday began with a trip to the famed Friday craft market, where the original creators of many of the crafts sold around Kampala convened to sell their products themselves, significantly lowering the prices by cutting out the middleman. With only an hour to peruse the selections due to an unfortunately but unavoidably delayed private taxi, we stormed the market each doing our best to collect as many cheap souvenirs as possible without going completely broke with a day and half left before heading home. There were baskets and drums and sculptures and necklaces galore, and I think I did a pretty decent job displaying will power. I only spent about twice as much as I anticipated.
I would love to write more, but the USA vs. England World Cup game is about to start, and since anybody reading this probably knows me well enough to ask about the events in person anyway, I'll let the game take priority for now. The blog will hopefully resume on Monday or Tuesday after safely returning home.
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