After a relaxing weekend exploring Ghana and its culture, I started Monday with the usual morning meeting. These meetings are not only a great way for me to learn the details of complex cases, but also for me to track patients’ progress as I observe many of them from pre-op to post-op. Some upcoming surgeries include Eshetu, a nineteen-year-old woman from Ethiopia that I know from teaching. She has congenital kyphosis of 93 degrees that has visibly thinned her spinal cord. Her condition is so severe that she currently walks with a stick. Another is Mengistu, a nine-year-old Ethiopian boy who was previously treated here for post-tuberculosis kyphosis with spinal fusion and vertebral column resection (VCR). After his original surgery, he underwent another procedure to remove an exposed and infected implant, in addition to rounds of antibiotics. After six weeks of traction, the patient is ready for his third procedure, which will re-add hardware. Unfortunately, these situations are often unpreventable because such small patients need small instrumentation, but at the same time the hardware must be strong enough to not become misplaced. We also reviewed post-ops, and I wanted to share how well Bai (the buckled spine) is recovering. He is now five days post-op from a posterior spinal fusion, VCR, and cage implementation for kyphosis. His surgery was four and a half hours long, and today his drain is removed and he is walking! Bai took part in many of the activities I did throughout the day and had a hearty appetite at lunch. Esther is also doing well, experiencing less pain, and enjoying coloring!
Physiotherapy (Physical Therapy, PT)
n the morning I observed physical therapy with the patients from JB House whom I had taught before. PT is so important in orthopedics, as patients must relearn how to use and restrengthen parts of their body necessary for activities of daily living. However, spinal surgery requires a lot more because of the extreme nature of the surgery and the spine’s control over nearly every part of the body (not just your back). PT is crucial in pediatrics so that patients are not sentenced to being forever physically inhibited by their previous challenges. The children have such strong relationships with their therapists, whether it’s being motivated to work harder or confiding in them about personal feelings. One little girl is upset that her friends are progressively leaving while she’s still in recovery, and she openly talks to her physical therapist about this and receives words of support and inspiration in return. The patients know their routines and begin their ankle weight exercises as soon as they begin, which include separately lifting their legs both straightened and bent while seated. After a certain number of sets, they add in raised arms. Other exercises include walking up and down stairs with ankle weights, doing single-leg kneels both on the mat and while putting down and picking up markers in a line, using arm-strengthening bands, and balancing on their toes. Some of the children practice walking normally, as they previously bent their necks and hollowed their chests into their shoulders in a hunchback-type posture. The therapists also stretch out the children, especially in their necks which are still supported by braces.
Hanging With the Pediatric Patients
I spent the rest of the day following the daily routine of the many pediatric patients who stay at the hospital. The children already had breakfast before physical therapy, and after PT came learning with Auntie Patty. Patricia has emphasized to me that while teaching the patients is important and occurs daily, it is very difficult because of the varying education levels, ages, and languages. However, her main goal is to use educational activities like reading, writing, and mathematics to cheer them up amidst all that they are experiencing. Our first activity was coloring. In order to get a sticker prize, the students had to color their picture to the best of their abilities and write their name. The children who are unable to write in English practiced by having their name written for them so that they could try to copy it below. The patients were so thankful that I brought new coloring books, and drawings from Dora and Frozen were a hit among boys and girls. I then went to lunch with the children. Here they are closely monitored to ensure that they eat everything. As in many activities, the older patients led the way by listening and eating quickly.
After lunch I read a book to the kids, which involved a lot more than reading. After every sentence or two, Auntie Patty and I stopped to ask the children what had happened. Sometimes a handful of children understood and explained it to the others. On the other hand, Patricia and I often reexplained the sentence in multiple terms, using images and gestures frequently. We then asked the kids follow-up questions about the sentence read to ensure that they understood it and we could move on. After the story, the children read their own books because June is Reading Month and they are in a competition to see who can record the most pages in their reading log. Many of the children can read in English at an elementary level, but those who cannot use books in their own language.
When teaching was over, each of the patients got some more little toys and lollipops for their participation. I then accompanied the patients on their traction walk. The traction walk takes place twice a day, once in the morning and once in the late afternoon. The children’s halos are disconnected from the equipment on their wheelchairs and attached to the same apparatus on standing frames so that they can move their legs. Post-op patients who were either walking without halos full-time or unfortunately wheelchair-bound participated, encouraging their peers. This type of group spirit can be seen throughout the day and is constantly inspiring me. I’ll be spending a lot more time with the kids this week, so stay tuned!