It is difficult to leave

August 11, 2010

It is always hard to leave the patients and staff here at St. Gabriel’s – although I know I will return to continue to be a part of the efforts to provide health care in this community. I have not written much about specific patients I have followed during my stay because I am respectful of their privacy.

I have provided physical therapy for several young men who have had amputations – and some elderly men as well. There is not an opportunity for them to have prosthetic limbs, so the care is management of the surgery site, and ambulation training.

I have also provided physical therapy for several children who have sustained femur fractures and have needed to be in traction for three, sometimes four weeks. One of those was a fifteen year old, who had a femur fracture as well as a large flesh wound after a motorcycle accident. The other causes of fractures have been falling from heights, and playing soccer.

I have also been closely involved in patients who come to the hospital after having a stroke. I provide physical therapy in the ward, and then extensive rehabilitation in the Family Care Center Unit. A large part of post-stroke rehabilitation is working with the family members so that they can support the recovery process at home.

Burn patients who have second or third degree burns to their hands, elbows, shoulders, knees, or feet also receive physical therapy. For these patients, I work closely with the clinical officers who are doing wound care and daily dressings. Splinting is done if needed. Because so many women and children spend a lot of time around the fires at this time of year – I have found that many times the patient is epileptic and has had a seizure and fallen into the fire.

I have also been involved in rehabilitative care for a child with cerebral malaria. She has apparently suffered brain hypoxia during her critical illness, and now has poor motor, speech and cognitive abilities. A few times a week, I visit homes with the home-based care nurses – or follow patients in their home after discharge for rehabilitation. So, we will leave tomorrow morning for home. It will be good to be home, of course. But, the people here will stay close in my heart.

These pictures from Lake Malawi shows a tree growing out of a rock – extending its roots far away from the tree trunk. A great symbol for the process here of coping with resource limitations – and thriving.

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Family Care Center Unit

August 9, 2010

I am amazed at the progress here at St. Gabriel’s – once again. The first year I came, they had just completed a new Labor Ward. The following year – the Private Ward. The next year – the new Pediatric Ward. Last year, they completed the renovations for the Surgical Ward.

This year, the Family Care Center Unit (FCCU) is providing palliative and rehabilitation care in a new facility. The Antiretroviral Treatment Clinic, counseling, and pharmacy are also in the same building – in addition to the office of the Home-Based Care Nurse Coordinator, Frontline SMS and a conference room for training sessions.

Most of this – ART care, home-based care, training, counseling, and rehabilitation care – have always been a part of patient care here at St. Gabriel’s. However, they have had to work in cramped spaces, patients waiting in crowded hallways, and training in makeshift rooms. They have always done their best.

With the new facility, however, they have been able to organize a group of staff members trained in palliative care. We take care for chronic conditions, and the end of life for granted. St. Gabriel’s Family Care Center Unit is the first hospice in Malawi. I know they have received generous donations from several sources – but I would like to acknowledge one of them – Capital Hospice– who are based very close to me in the DC area (www.capitalhospice.org).

I have been so impressed with the support the families of patients in the FCCU receive. Admission to the FCCU starts with a very thorough family and patient assessment and the establishment of patient/family-centered goals. They help the family to understand the patient’s diagnosis, pain management, and rehabilitation potential. In addition, they talk about the role of family members in the patient’s care – should they prefer to care for the patient at home.

The home-based care nurses, Alex and Matilda, provide that continuity of care – following up on the patient’s needs at home, providing resources to the families caring for their loved ones at home, and recommending admission to the FCCU if the family needs respite.  Although communities really pull together to help each other – sometimes the resources are lacking. In many families, the burden is great – with many family members needing health care support. The home-based care nurses are trained to be able to recognize signs that patients may not be well-cared for at home – and they can offer support through FCCU.

Welcome to the Family Care Center Unit

FCCU staff

FCCU staff in the reception area

FCCU staff at the outside entry of the unit

Jeff is in Malawi

August 4, 2010

Jeff arrived in Malawi last Thursday afternoon and since then he has had a whirlwind introduction to Malawi. He flew from DC to NYC Wednesday morning to catch a direct flight to Johannesburg (16 hours), and a connection to Malawi (2 ½ hours). The drive from the airport in Lilongwe to St. Gabriel’s in Namitete is about 1-2 hours depending on the number of goats in the road, roadblocks for license checks, or speed traps.

On Friday, he got a tour of the hospital with some visitors from the University of Pacific and a Rotary Club in California. Saturday and Sunday we were busy visiting families that we have gotten to know, but had not yet met Jeff. He spent Saturday teaching Prince Patrick, the four-year-old son of Deus, one of the Health Surveillance Assistants at the hospital, how to play baseball. Sunday, he spent helping a former patient edit a book he was writing about his experiences as a person with a disability in Malawi for possible future publication.

Monday, we went into Lilongwe (the capital, about an hour away). Jeff came with me to meet with the Medical Council of Malawi, where I presented a proposal for distance learning modules for continuing education for Malawian physical therapists – which was accepted. We then hopped on another mini-bus to find the Children of Blessings Trust – a children’s rehabilitation center in Lilongwe. I will be implementing the FrontlineSMS: Medic cell phone network system for the center in the fall or spring.

While we were in Lilongwe, we got incredible fresh vegetables at the huge open-air market, visited a few bookstores, and had hot chocolate at Mama Mia’s – a very European café.  Jeff also had a blast bargaining for some woodcarvings. The craftsmen are quite an aggressive crowd, but Jeff quickly befriended one of them and his brother – Louis and Roderick.

Yesterday, Jeff spent most of the day helping at the outreach vaccination and pre-natal clinic. He is going back this afternoon – but wanted to be able to help with taking blood pressure, so he had a quick lesson this morning from the nurses in the Family Care Center Unit!

The nurse, Comfort, teaching Jeff how to take blood pressure

Of course, he has also helped in the pharmacy – counting pills, and learning Chichewa from Sister Honesta.

Jeff counting pills in the pharmacy

Learning Chichewa with Sister Honesta

So, it has been a busy few days!