Happy Birthday Mom!

Some days like today I wonder what I’m doing here in Kenya. The last five days I have been really sick and I’ve been trying to push through at work in order to teach the physios, give my in-services, help patients, and teach the exercise classes but my body is just hating me and I feel like crap. In addition, there have been so many patients that have come into the hospital and clinic recently that have broken my heart. I could go on and on describing their illnesses and diseases but it just makes me too sad to even talk about right now. On days like this I need encouragement and who do I get it from? My mom. Yes, I am almost 25 years old but I still love my mom more than anything and I still need her in my life more than ever before. She more than anyone else knows how to speak right to my heart so I dedicate this blog to her for her birthday ; )

My mom is my hero for a lot of reasons. First of all, she's one of the most selfless and loving women I have ever met. She has given up so much of her time and energy to help me throughout my life. I know there were countless sacrifices she made for my brothers and I growing up but I can't help focusing on all of the ones she's had to make most recently.  I think she thought it would get easier to raise me with time but I've actually become more difficult since I've moved to 5 new places since May (going on 6 here in 10 days) and with each move comes uncertainty and difficulty with transition and who do I call and vent to? My mom. It was so wonderful to have her in Kenya with my dad. She worked at the Rift Valley Academy near the hospital and the kids there absolutely LOVED her and they get so excited when they find out that I’m Mrs. Greenwald’s daughter! But she also played full-time role of encourager and cheerleader for my dad and I when we would come home from the hospital complaining and grumbling about our tough days working in a 3^rd world country hospital. Not only that but of course she’d have all of our water filtered/boiled so we could drink it and she would have the fruits/vegetables soaking in bleach so we could prepare dinner together. I’ve been struggling to survive on my own without my parents here!

My mom not only loves me well but there are so many ladies and families in the community that she loves as well. Her schedule is always full of such good things and all of the activities involve using her gifts to help others. She's a wonderful listener. A wonderful encourager. A wonderful supporter. A wonderful mentor. My mom is a mentor to a lot of young women and moms and she is excellent at it. Sometimes I can’t help but think what my life would be like if I would have listened to my mom’s advice all the time? I probably would have been sick way less time, stressed way less about school grades and shed fewer tears from broken relationships.

That leads me to my second point, my mom is so wise. She is such a talented writer and she is full of so much wisdom from so many books! I love it when she shares quotes and/or themes from books with me and speaks truth into my life through them. I’m reading a book that my mom recommended to me called “It’s Your Call” and in it there’s a quote that states “Jesus came with a mission and a purpose --  to bring life to others.” Then the author, Gary Barkalow, goes on to describe how we are supposed to do the same thing. My mom does an excellent job of this. She is “life giving” to me and the rest of my family as well as the other people in her life.

Third of all, my mom values the most important relationship in her life more than anything else. She loves and serves the Lord with her whole heart and she spends quality time with the Lord every day. She listens to the Lord on a regular basis and because of that she is able to give such wise counsel.  My mom is continually seeking out her calling from the Lord and is constantly spending time with God in order to find out His will for her.

I really hope and pray that one day I can be as humble, wise, gracious, and loving as my mother!

The Story of Elisha

My parents and I have had the privilege of getting to know an older Kenyan gentleman because he has been driving us around the area and we have gotten to hear a lot of his stories. His story is one of the most unique and inspirational I’ve ever heard so I wanted to share:

Elisha was the youngest of 14 children and when he was a little less than 1 years old his father got TB of the spine and he was paralyzed from waist down and unable to work. Because of this their family had no money and there was no one who was able to provide food for the family. Only 7 of the 14 children in his family survived during this stretch of time. Elisha said that there was one time his mom left his dad and his siblings in order to go get food for them but she was gone more days than expected and he said “We were all almost dead. I would say we were half dead, almost full dead.” At this time there was someone in their village who came and gave them milk and Elisha said that the milk kept him and the rest of his family alive. He reported that at the moment he remembers vowing to himself and to God that someday he would provide the starving with food just like this man had done for him and his family.

When Elisha was 18 years old he knew he had to leave his village if he ever wanted to make a living for himself. He walked for 1 full month, a total of 100 kilometers, with no shoes and no money because he heard that there were missionaries at Kijabe hospital that helped people in poverty like him. When Elisha got to Kijabe his clothes were torn up, he was starving and exhausted. Elisha was able to meet a missionary at Kijabe and the missionary and his wife welcomed Elisha into their family and “adopted” him as their own. They gave him his first pair of shoes, new clothes, they fed him, gave him a roof over his head, and paid for him to go to school, and helped him get a job etc. They also were able to teach him English so that he could get a good education. This missionary family literally gave him everything he needed to start his life anew. Because of this Elisha was able to get a good education and a job where he met his wife. Fast forwarding in his life he started a business driving the Kijabe missionaries around because the driving is CRAZY here and the roads are AWFUL and most missionaries don’t feel comfortable doing it on their own. He was able to raise 4 kids with his wife and 2 of them were able to go to college in the US because he “sold everything to pay for their education”. He has now been able to go to the US twice over the last 5 years and it was so fun to hear him describe his initial impressions, especially when he described riding on a boat on Table Rock Lake in Branson, MO! (he had the biggest smile ever when describing how much fun it was)

Elisha says that through it all, from his rough childhood until now he can “always see God” in his life. There are several parts of Elisha’s story that stick out to me. One of them is that the couple that “adopted him” literally saved his life. I don’t know if they realized at the time how they were changing Elisha’s life and his whole future families lives as well. This makes me think about how much of a difference ONE PERSON can make by reaching out to another person in need.

The other part of the story that is so cool is that when Elisha told himself that someday he would help feed others who were starving he was serious. 20 years ago Elisha was driving around a short term medical missionary couple and he was sharing with them his dream of feeding the hungry kids like he had once been fed. This couple continued to come back to serve at Kijabe and they stayed friends and when the couple moved to Kenya from Texas 5 years ago to start an orphanage called Naiomi’s village Elisha gave all of his farmland that he owned to them so that they could profit from all of the crops. Now those crops are used to feed the 50 children that live at the orphanage. I love the “pay it forward” example that he was able to live out. His life was saved by one man at a young age and now Elisha gets to be a part of feeding 50 orphaned children.

I have been so blessed to have gotten to interact with such a Godly Kenyan man. May we all live with this same kind of faith, courage and love for the Lord!

Surprises of Kenyan exercise classes and races...

Today is one of those days that I'm just blown away with how full life is with surprises. Over the past week I've had a great surprise of teaching exercise classes in Kenya! My first week here I was telling the head Kenyan physio that I teach exercise classes and he was so excited because he said he's been trying to 1) teach the rest of the physio staff basic exercise moves to share with patients and 2) show the hospital administration how important exercise is and how many workers at the hospital are interested in it so that they can have exercise options/a gym at Kijabe. Immediately the head physio made posters and told me to personally hand them out to every department at the hospital. So I went around and shared the poster:

Exercise class for all Kijabe women

All ladies and fitness levels are invited for cardiovascular endurance and full body strengthening

Good shoes and exercise attire recommended

If questions contact Dr. Anna Greenwald in physio dept

I was curious to see how many ladies would attend the first class because Kenyan women have ever been to a gym or done any type of exercise/aerobics other than walking to and from work everyday. Even though they have very little experience with exercise they do have a lot of interest in it and honestly they also have a need for it. The majority of Kijabe village does not eat as healthy (the majority of their diet is fried food) or as little as they used to and also they do not have to walk as far of distances as they used to due to the increase in buses and 'mutatus' or taxis. I have seen a lot of patients who are overweight in the wards/clinic but even if the patients are not overweight I would say that 95% of the patients here have no idea how to use their muscles to protect their joints and if they did they could prevent a large majority of the back/leg/arm musculoskeletal problems that they have.

The first exercise class I had on Tuesday had over THIRTY Kenyan women! They all came in their long skirts and their blouses and we had the first exercise class ever held in Kijabe village. The women got SO into the workout moves. I had a really hard time not cracking up throughout class because their interpretation of the moves I was doing was absolutely hilarious. After class all the ladies came up to me and told me "We love it. We have to do it everyday." I told them I would be leaving in a few weeks and they said "Okay, we will videotape you and do it everyday after you leave." I had no idea how excited the Kenyan women would be about this!

We had another class during lunch break on Thursday and even more women came with the same energy and excitement as before! When walking through the hospital now I have all these Kenyan women come up to me and say "Thank you so much. I love your class. Please don't ever stop doing it." After class on Thursday I went to talk to the hospital administration about videotaping a class and showing it to staff on a regular basis and they said "We will look into it. But we need you to lead the warm-up for our race this Saturday." I wasn't really given a choice but of course I love exercise so I was okay with leading an exercise warm-up before the race. The "Kijabe Rift Run" race has been done annually over the past few years to raise funds for prosthetic limbs for patients at the hospital. The motto for the race is "Run to Save a Limb".

So I showed up this Saturday morning to lead the warm-up and run the race and o my lanta was I in for another HUGE surprise! There was a group of 100+ Kenyans waiting for me right on the side of the interstate with booming African booty-shaking music and a mic. They first had me stand about a foot from oncoming traffic on the interstate but then they had me stand on an elevated riser that was projecting from a Coca-Cola semi truck. They told me the warm-up would only be 10 mins so I started with my normal routine but of course everything runs on African time so I was up there for 30 mins leading both the kids and adults in an aerobics class! Everyone got really into it and they were all shaking and moving in ways that I can't even attempt because my body doesn't move that way since I'm not African...

When I signed up for this race I had no idea how long it would be or what the terrain was like but I found out while running that it was at 9,000 ft elevation on all hills for 12 kilometers (~7 miles). I was one of the only "mzungas" or whites that did the race so through every village we ran by there would be lots of children and adults who had stopped their work and would wave and clap and yell at me and some even ran to give me high-fives. I had no idea where the running route went so I just stuck with a Kenyan high school boy named Ian who was running the same pace as me. I was very humbled because he ran the whole thing barefoot (like almost all of the Kenyans did) and the roads were absolutely horrible- very rocky and bumpy so his feet were bleeding by the end. But we chatted the whole race and it was fun to get to know him. After I finished the hospital staff and Kijabe villagers were cheering so loud and a Kenyan with a mic came up to me and was so excited "You won the race for females! We need to interview you. Come with me now!" So he grabbed my hand and interviewed me in front of hundreds of people that had gathered for the festivities. The post race celebration was a banquet because the governor of Kenya was there to dedicate a new wing of the hospital so when they announced the race winners they called my name and I had to walk in front of the hundreds of Kenyans to get my medal and certificate and a picture with the Kenyan governor. After the awards ceremony was over I had over 50+ people come shake my hand and look at my certificate and then there were tons of school kids gathered around me who wanted to wear my medal so they passed it around. I have never felt like more of a "celebrity" in my whole life and I'm sure that I never will again which is fine because I don't necessarily enjoy being the only muzunga in front of hundereds of Kenyans! (As I am telling this all now it still feels like it was a dream but I promise it wasn't because honestly, how could I even make all this stuff up in my wildest of dreams?!?! haha)

What a CRAZY week! There were lots of hard moments in the hospital but what a blessing to have the exercise classes that the ladies are so excited about and that I think can be beneficial in the long run to the Kijabe workers health and well-being. Also, how crazy that I just literally got thrown into leading the warm-up of a race and got to be in a picture with the Kenyan governor? Wow, life is full of surprises!

I can't wait for the exercise classes this week as I think that they will continue to grow more and more. I had one of the Kenyan guy runners come congratulate me today (he won for the males because he ran 5 min miles in that ridiculous elevation and hills which is insane) and he asked if I would start leading classes for the males as well. So we'll see if that works because there are cultural barriers here that might prevent that from happening.

PS- For those of you who have attended my workout classes before I want you to know that the classes I lead here are VERY different from the ones I lead in the US. I have them do a lot more clapping and dancing and a lot less BURPEES and plyometrics! We all know that they would never come back if I had them doing burpees in their skirts ; )

"Christmas" in February

“In America, if 2 out of 10 patients die then you are devastated that you lost 2. If Kenya, if 2 out of 10 patients live then you rejoice in the 2 lives saved.” This is a quote I’ve been reflecting on this week which was said by an American missionary doctor here at Kijabe hospital.  It’s been a huge adjustment to change to this new perspective. When a patient dies next to me and no one seems to be grieving it is hard to understand or when a patient is coding and no one is rushing to their bed it is hard not to get angry but the reality is the quote above…the Kenyans just choose to rejoice in the lives saved.

Overall, I am so impressed with Kijabe hospital- the way that they use their very limited resources in order to provide the best care for their patients is amazing. One of the best parts of the hospital is the Bethany center which focuses on children with neurological disorders like spina bifida. Kids come from all over East Africa on grants to see one of the best pediatric neurosurgeons in the world. Another awesome part of Kijabe is that it is a training hospital so they get to train the 40 orthopedic surgeons in the whole country of 34 million in Kenya. Also, they got to train some of the first and only orthopedic surgeons for some of the African countries that have less access to good healthcare. What excites me about the opportunity to be at this hospital is the concept of sustainability. My dad is training and educating ortho residents who will be helping this country for years to come and I am trying to do the same with physiotherapy. It’s a bigger and more lasting impact than just a couple weeks of treating patients. When Kijabe hospital first opened there were no Kenyan nurses or doctors but instead it was an all American/British staff because the Kenyans had no training programs. Now the majority of the staff is Kenyan because there is a Kenyan nursing school at Kijabe and there also are lots of resident training programs here.

Being in Kenya constantly makes me realize how many things we take for granted in the US. You can start with the basics like being able to drink the water and having electricity and internet, etc. But when my mom asked the question of “What do you appreciate from home now because of this trip?” my immediate answer was our healthcare. It’s crazy what you take for granted in the US regarding quality healthcare and an ample amount of medical supplies. All third world country hospitals have very limited budgets (Kijabe being one of them), therefore, supplies and space are very limited. On more than one case I’ve seen a physio use a towel for a shoulder sling and also a sheet be used for a gait belt. Space is limited as well. Picture this: I said in an earlier post that the physio room is 12x18 room but on orthopedic patient days it’s so busy that we have 7 physios in that small room seeing patients. They actually count squares on the floor and give each physio a space that is 30 ft big (5x6). It’s crazy that patients travel at least a half day to get physio treatment in that small of space with such limited supplies but there really aren’t any other options!

My dad has told some interesting stories about the OR (called a theatre here). For example, there are huge lights that have 10 light bulbs each but they typically are down to 2 of the 10 light bulbs working so it can be very difficult to see when operating. Also, he walked into a surgery after the Kenyan orthopedic residents that he was supervising one of our first days here and the theatre nurses said they were all out of gowns so he couldn’t be in there! And he says that he wears his face mask more than one day in a row because they don’t have enough to wear new ones. To any healthcare professional that has practiced elsewhere let me just tell you that the stuff you see and do here is just crazy. But they definitely do the best with what they have.

The good news is that we celebrated “Christmas” with the ortho and physio staff this week! They call it “Christmas” when they open supplies that short term missionaries bring that they are in dire need of.  It was so fun to see the physios and doctors open up the bags we brought (over 150 lbs of equipment) and their eyes just lit up like little kids do on Christmas. They immediately started talking about all the things they could do with it and how they’d been waiting and/or asking so long for that piece of equipment!

---Another Kenya beginner lesson learned: When running at dawn and you see a guy standing in the field next to you with a machete you don’t have to sprint due to the assumption that he is going to cut you…instead he’s just cutting the grass. Often they will cut whole fields of grass with a machete knife ; )

The Dynamic Duo

Sometimes the daily frustrations of life here are overwhelming…the water in our house hasn’t worked for days so I haven’t showered for a long time (probably TMI, I’m sorry) but even if the water is working we have to filter and boil it before we even brush our teeth with it, and the internet hasn’t been working for days and I desperately have needed it in order to fill out all of my CO PT license application. (it takes a month to go through and I’m supposed to start on March 11^th)

But today I need to focus on something positive rather than on all of the frustrations so I’m going to share about the “dynamic duo” that my dad and I have become here at Kijabe! We have been giving in-services to the physio department over the past week. One thing PTs (mainly the techs) do here is casting. Therefore, my dad and I gave a PT seminar on casting which was “extremely helpful” to them. First of all, it was fun for them to be able to meet my dad who of course was very enthusiastic and full of energy. Secondly, they all were very excited to learn about how to cast properly. Thirdly, they were in desperate need of a new cast saw and we were able to bring one from the US and donate it to the Kijabe physio dept. The physios are not actually educated on casting in school but it is something that the hospital expects them to do. (For example, throughout the day we’ll be treating patients in the outpatient physio ward and nurses/doctors will bring their patients straight from surgery in their gowns and so that we can cast them right then and there.) During the in-service my dad and I sat up in front of all of the Kenyan physios while he put a cast on me and quizzed me on lower quarter anatomy and then he talked about how to properly cast. Thankfully they were also able to learn how to safely take a cast off and they practiced with the new cast saw on my cast.

The second in-service we gave was on ACL reconstruction. The lecture started off on a rough note when I asked “Who can tell me what the ACL is?” And all I got was a bunch of blank stares. I’ve talked with several UK/US Doctors who say that this is actually part of their culture. When asked questions during lectures Kenyans typically do not answer. But my dad was able to tell them about what he does during an ACL reconstruction surgery and then I was able to talk about the rehab process, both inpatient and outpatient. It was fun to get to teach them together! My dad was able to complete one of the first ACL surgeries here at Kijabe hospital with the Kenyan orthopedic residents he is training yesterday and I was able to complete her PT session with the Kenyan physios today.

It’s been really fun to work on the same patients together! The pathology of things you see here is crazy- things I’ve never heard of or learned in school and things that my dad has never seen in his 30+ years in the medical field. The hospital gets a high population of trauma because of the large number of car accidents that happen in Kenya. Trauma accidents are in the top 5 leading causes of death here and it kills more Africans than both AIDS and TB.

The MRIs and x-rays of patients that you read here are just unbelievable. My dad and I will be looking at them and the only response possible is just for your jaw to drop. There are so many examples I can share but a lot of them don’t do proper justice unless you see the pictures for yourself. Unfortunately I can’t upload them because of the poor internet but a good patient example is an adolescent girl who was burned across both of her legs 10 years ago and she developed heterotopic ossification so badly that her left knee joint was completed fused in extension for TEN YEARS! Therefore, she has not bent her knee since then and has been unable to move well at all. So she came to Kijabe hospital last week and wanted to get her leg to move again but her quads are completely atrophied. My dad was able to complete the surgery on her with several of the Kenyan orthopedic residents and they got her knee to bend to 120 degrees while she was under anesthesia and now I am doing her physiotherapy. The rehab process with her is extremely difficult because her knee is so painful for her to move and it’s also hard to teach her how to use her quad muscles again when she hasn’t used them in 10 years. But I’m thankful that we can try to help her and I’m also thankful for the learning process we are undergoing.

It’s been fun to get this unique opportunity of working closely with my dad. We are both pushed beyond our normal areas of practice and have been challenged in many ways but I think I speak for both of us when I say that we are thankful for this learning and growing experience together!

Fridays break my heart

The physio clinic at Kijabe hospital has a pretty scheduled routine: Mondays and Thursdays are back pain patients, Tuesdays are plastic surgery patients (skins grafts and tendon repairs, etc), and Fridays are pediatric days. All of the days are full of their own upsides and downsides but I found out that Fridays will be the hardest by far. Peds days are when the mothers bring in their children whom have developmental delay of some sort, such as cerebral palsy. This week one patient particularly had an impact on me. The session started when the toddler peed through his pants and thin cloth diaper all over me but honestly that didn’t bother me that much or stop my treatment because all I could think about was that this 3 year old boy was being seen by a doctor for the first time since birth even though he was not able to lay on his stomach, crawl, put any weight on his feet while being held, or even communicate a single sound. 

At first it was hard for me not to be frustrated with his mother for waiting so long to bring him into the hospital but I’m guessing that the majority of the reason she waited so long to bring him was because of lack of funds. Even though Kijabe is a mission hospital the services still are not free and can be too expensive for many patients to afford.  (Believe me, If I could treat every patient for free I would). I don’t think this child will be able to come back to the hospital again for this reason so I only had 20-30 minutes to do exercises with him and to teach his mom what to do so that he can progress through the necessary developmental milestones. Now remember that I don't know any Swahili and his mom doesn’t speak any English so the treatment session was a little less than ideal to say the least. For a normal peds PT session in the US you would have toys in the clinic to distract them while doing exercises but they don’t have any at Kijabe so the boy just cried and cried.  Thankfully at the end of the session I was able to grab a physio who was seeing patients in the ward and I asked him to translate for me so the mom could know what to do with her child at home. At the end of the session his mom left to go pay and I got to soothe and cuddle this precious kiddo and right then and there my heart just broke. This child had undiagnosed CP and nothing was going to be done about it. It is very hard to see kids that have any level of developmental delay or disability in the US but it is even harder to see them in a country where there aren't government programs that provide therapy for these kids. It really makes me think about how many kids there are in third world countries that are mentally and/or physically handicapped and they do not get the care or support they need or deserve. I could go on and on but let’s just say that Fridays break my heart because there are lots of other stories like this 3 year old boy. I will need extra prayer that I can help these precious kiddos and that I will be able to effectively teach their mothers how to help their kids.

Okay I really hate to end on a low note so I want to share a REALLY funny story. Since my dad is doing ortho surgery here at the hospital he will frequently come into our physio room and talk to me about certain patients and etc. so on Thursday he got to meet the whole staff.  They all liked him (mainly because he made fun of me) which later got the staff started on asking me questions about the rest of my family and if I was married. (Here in Kenya it’s very important for women to be married so I frequently get asked by Kenyans if I am.) Then they started asking me if I would marry “outside my tribe” because tribes are of great importance here and a lot of people wouldn't consider marrying outside their tribe. I was explaining that in the US there are a lot of marriages between different “tribes” or races. They asked if I would consider this and I said that I would. They seemed confused by my answer so they asked me several times to clarify. (A lot of times questions/answers have to be repeated because English is not their first language and also they have such a thick accent that it’s hard for me to understand them. Thankfully they are very patient with me!) Then they asked me if we did arranged marriages in the US and I said no and proceeded to say that my dad would not choose whom I would marry but that he would have to approve of the guy. Then they went off on this string of questions which was more than they had asked me all week combined “What is your spiritual life like?” (spiritual life is of great emphasis here) “Are you a good cook?” etc. You have to realize that the whole time during this conversation I was so excited because they were communicating with me way more than they had before and we were starting to be friends! What I didn’t realize was that I walked straight into a brick wall of marriage proposals. Since that conversation I’ve had two informal marriage proposals. One older woman physio keeps telling me that she is going to talk to my dad about me marrying her son and then another young guy physio constantly tells me he is going to talk to my dad himself about marriage. I wish I could say that both of these physios are joking, and at first I thought they were, but they’re really not. Throughout the workday they keep asking me where my dad is and when they can talk to them. So it looks like I’m going to change my mind on the Fort Collins PT job and instead take a permanent job as a physio at Kijabe and be a wife for one of these two great Kenyan men.

Haha, just kidding...I’m just really hoping that when I kindly decline their offers that they won’t hate me because I really do want to be able to work well with them and the rest of the physios on staff and I don't want any drama getting in the way! 

Life as a Kenyan Physio

There are so many stories I can tell from the outpatient physio clinic and I really don’t know where to begin. First of all, imagine a room that is 12 x 16 ft (and that’s being generous). There are 3 treatment beds and 3 desks and a corner full of all the assistive devices and equipment for the whole hospital. I wish my internet would let me post the pictures of how small and crammed this room really is.  The schedule is made so that 10 patients are signed up for both a morning and an afternoon session. This morning the patients all arrived at 8:45am for their 9am session and some of them weren’t seen until 12. In the US it seems like if you start a patient 5 mins late then they get angry. But here it’s a little different because the physios don’t even apologize to the patients for the late start, it’s just assumed. The schedule definitely runs  on “African time” so of course we take our time chatting with patients/other physios and taking “chai time” is necessary as well.
 

I made my millionth mistake today in the outpatient physio clinic. Listen to this: I made a patient sweat. Unbeknownst to me, it’s a general rule for Kenyan physios that you never let your patients perspire. I was working with one of my patients and she was doing some core exercises for her lower back pain and she was working hard so naturally she started to sweat. The physio who was seeing patients next to me actually came over and said “O my, she is perspiring! She needs to lay here and rest for 5 mins and after that no more exercises for today.” Can you imagine if all PT sessions were stopped when someone starts to sweat? Gosh I would never make it through a PT session!

There are so many reasons why it’s difficult to treat patients here but one main one for the women patients is that they all wear long dresses/skirts. Trying to teach patients how to do back/hip/knee exercises in skirts can be VERY interesting. Also, around 20% of the patients are Somalia or Sudanese Muslims and they are covered from head to toe so treating these patients can be even more of a challenge.

I’m realizing how hard it is to instruct a patient on a home exercise program without speaking the same language. I should videotape it sometime because I’m sure it’s very entertaining. I used to think that it was hard to instruct patients at the University of Iowa mobile clinic which had a high population of Latinos but my Spanish skills are a million times better than my Swahili so now the mobile clinic sounds like a piece of cake. I actually had one patient today who knew a few basic words in English and the session seemed to go so much better than the others have. When I get back to treating patients in the US I seriously think I’ll find it to be very easy compared to what I’ve been doing. I know everyone says your first PT job is really hard but I don't know if it will feel as hard to me because of this experience.

I fully realize that all of these observations I've made might sound like "complaints" but I'm really not looking down on Kenyan physios at all. I know that there are just very different ways to do things. I realize that I can either let all of these things here completely frustrate me and let them steal my joy or I can just embrace them and appreciate the many differences.

Adjusting to this new environment has been very challenging to say the least but I want to share my highlight. Today I got to work with a little 5 year old boy who had a bad elbow fracture and had just come out of his cast so he was sent to physio in order to prevent an elbow flexion contracture. It was miserable to work with him at first because he cried hard the ENTIRE treatment session and I couldn’t even explain to him why it was necessary to move his elbow because he didn’t know any English. It just broke my heart to see him crying so hard and not knowing why I was hurting him. (The physios here are all very rough with their treatments and they don’t show compassion towards their patients in the same way. It’s more of a “tough love” type of thing, especially towards the kids.) Anyways getting to the highlight…when the treatment session was over the cute kiddo stayed in the physio room waiting a while for his mom and I was able to play with him! All the games I gave him involved extending his arm so we played patty cake and “heads, shoulders, knees, and toes” etc. for almost 30 minutes. He laughed and laughed and it made it all worth the many frustrations that I’ve experienced here so far. God knew I needed a little bit of encouragement in my day so he sent me this precious 5 year old to make me smile and laugh ; )

First impressions at Kijabe

Here are some Kenya beginner lessons that I've learned:

-Always walk on the left side of the path/hallway...otherwise you WILL cause confusion for all patients/medical staff and you WILL cause a traffic jam in the hospital and they WILL all look at you like you are the new white doctor from the US. I only learned this lesson several times today...

-The animals that are running through the trees and fighting with eachother on the roof of your house are not squirrels, they are monkeys and they are NOT nice.

-Don't stop conversation and make "ohh" and "ahh" noises when the electricity goes off because it happens at least every other hour every night so people will just continue on their conversation like normal and pretend like nothing happened. If you say something about it going out they'll just ignore you and keep up the conversation like nothing ever happened.

-When people look at you and say “Karibu” they are not asking you if you want caribou coffee, instead they are saying welcome! When I first came I thought that "Jambo" was the national greeting so I was confused why everyone was saying "Karibu" to us all the time...

-When they offer you chai tea at 10am and 3pm in the middle of your work day don't EVER say no, even if you are in the middle of treating a patient. I am used to never taking breaks at work so when I refused the chai they insisted that I sit down and drink it. Then when I returned to my patient without finishing my entire cup of chai they immediately stopped me mid-sentence so that I could finish my tea. My dad said that at 10am when they were starting there surgery they found 20 of the OR staff in the lounge drinking their chai tea. (And don't be confused with the chai tea...I'm pretty sure it's just whole milk and lots of sugar.)

Okay, now for the real stuff...

First days are always hard.

I forgot what a 3^rd world hospital smells like. It’s really hard to put the smell into words. I haven’t smelled it since St. Lucia and before then the only time I smelled it was in Haiti.  It’s not a pleasant smell. It makes my stomach queasy every time  I walk into the hospital. 

It's hard to do any kind of medical care in a 3rd world country...there are so many things that make it difficult and I'm sure that I'll be writing about a different aspect each blog. The hardest thing about doing PT here will be the language barrier. Although the physios here speak English they have a very thick accent and it is hard for me to understand them. I feel bad asking them to repeat themselves so I find myself nodding my head a lot even though I have no idea what they’re saying…hopefully this doesn’t get me into too much trouble.  In addition to not being able to understand the physios, I cannot understand ANY of the patients. I was under the impression that more of the patients would speak and understand English but they don’t. Their native language is Swahili and they barely know any English. This is difficult for me because as most of you know my favorite thing about working with patients is communicating and getting to know them. My second favorite thing about PT is educating patients. It’s really hard to educate patients when they don’t understand a word of what you're saying. I have already started getting creative with actions and I know that I will continue to do so but I don't know how much they're understanding. 

There are a lot of things they do here in the physio setting that I don’t agree with. For example, we saw 10 patients this morning and we did not change the pillowcase, sheets or towels once. I was thinking that we would change the sheets before the afternoon caseload but that wasn't the case...instead we saw all of our afternoon patients with the same laundry used before. The sheets were covered with red clay (the dirt here), dead skin from patients, and the remainders of casts. that had been sawed off. 

I worked with a lot of interesting patients today but one of them was a 3 year old girl who had an elbow contracture due to a 2nd/3rd degree burn that covered her whole right arm. She was a precious little girl who really did not like me because the last thing she wanted to do was to move her painful arm but unfortunately that was my main and only goal for our treatment session : (

Today I'm overwhelmed and I'm wondering why I’m here and if I really have anything to offer to the physios and the patients with the language barrier. At the same time, though, I am so grateful that I am here because I know that God has me here for a very specific reason...I just don't know what it is yet but that is okay. My plan is to live everyday to the fullest by learning as much as I can and trying to help as much as I can as well.

 

2 Corinthians 5:7 We live by faith, not by sight.

Pre-Kenya Part II: What am I doing there?!?

As I'm packing my suitcase and getting ready to leave for Kenya this Saturday the question I keep getting is "what are you going to be doing there?" So this blog post is going to summarize what I know about my upcoming role as a physical therapist at Kijabe hospital.

Kijabe hospital is a non-profit 350 bed hospital and the purpose of the hospital is to "glorify God through medical ministry." The hospital offers a broad range of inpatient and outpatient services to people from farming communities throughout the Rift River Valley region. There is primarily a Kenyan hospital staff but through World Medical Mission (part of Samaritans Purse) there are medical interns and voluntary staff from all over the world who go to serve and teach beside the Kenyan staff.

The rehabilitation department desperately needs western physical therapists to come and work alongside their physiotherapists. Kenyan physios have a two year degree post highschool and they are eager and grateful to any licensed physical therapists who can come help them further develop their clinical skills. My primary role will be to mentor and teach these physios. I know I’m a new grad and it’s a very ambitious role to take on but I also know it's what I'm being called to do. I was told that I will wear my white lab coat everywhere and that everyone will call me Doctor and that they will expect me to know how to do everything. Obviously the thought of this is completely terrifying and something that I was concerned about a lot originally because I feel extremely inadequate in this position.  But the staff has reassured me that they really need the help I can provide and that I have the basic skills and knowledge to fill the role. I definitely am grateful that Kijabe is a teaching hospital and that it will be okay for me to say "I don't know" because I'm sure that will happen some!

There are 8 physios on the rehab staff and one Kenyan physio director along with one American physical therapist who oversees the rehabilitation staff. Unfortunately, the head PT has left for a year long furlough (time off) in the US. So this means that I will have no American physical therapist guidance/direction while I'm over there. Thankfully, I've been in communication with the on-leave PT so I know some of what to expect. She is very thankful that I'm going because three new physios joined the staff since she left and they need to be trained properly; that training will be a large part of my job while I'm over there. I will spend the first few days observing the physios treating patients so that I can learn and see the gaps in their knowledge and clinical skills. Then I will spend about 2-3 days with each Physio supervising their work and acting as a clinical instructor. (Yes, this seems kinda crazy because I just got done having clinical instructors and I've never treated patients completely on my own yet...) Their physiotherapy degree program mostly requires memorizing protocols and lacks any clinical reasoning. The hospital wants to improve in this area so they can give better care and teaching to their patients. I've been told that the physios are quick to let the western PT take control of the therapy session but they don't learn much when that happens so it's better for me to ask questions and offer suggestions/give quick demonstrations so that they can maintain control of the session. Then when I return to the States they can continue to implement the new skills and knowledge I shared with them. 

I will be doing ALL types of PT while I'm there: acute care, orthopedics, joint replacements, fractures with ORIF and external fixators, amputtes, neuro, ICU, peds, NICU...etc. There will be very unique cases that I've never seen before like Tuberculosis of the spine that causes paralysis. I will probably also encounter a many amputees due to the large percentage of patients with gangrene and other infections. Brain injuries from motor vehicle accidents are also common due to their dangerous roads and modes of transportation. These spinal cord and brain injuries are dealt with very differently in Kenya than in the US. When I was at the inpatient neuro rehab facility at Duke this fall we had at least a few weeks with all the patients to do patient/family training. But for these Kenyan patients you only have a few days to prepare them for home.  I will be educating these patients and their families on how to prevent bed sores and contractures and also how to self cath, etc. 

On Wednesdays the hospital has ortho clinic.  I've been told that patients start lining up outside the hospital at 4 am and you often work until8pm that evening in order to see those who have been waiting all day. Most of these patients travel hours to days and you only have a short session to help them. On these days I'll be making splints/casts, doing equipment fitting, and educating patients and their families things like safe guarding techniques and gait training.

The Physio staff will have continuing education every Tuesday morning when I will be in charge of lectures/labs.  I have been in communication with the head Kenyan Physio and he has asked me to teach on PT for amputees, lower back pain, and total hip replacements.  I've spoken with an American PT who worked at Kijabe this summer who said these presentations can be difficult because some of the physios don't know basic physical therapy terminology.  For example, in the second sentence of her PNF lecture she used the phrase "eccentrc muscle contraction" which they had never heard of before and struggled to understand. I plan on making these lectures/labs as hands-on as possible so they can successfully implement their new knowledge with their patients.

So that's the basics of what I know. I’m so excited about the variety that will be present in my days. I feel confident at an entry level in all these different areas of PT since I'm fresh out of my clinical internships and my licensure boards exam, but I also know that this will definitely be the most clinically, physically, emotionally, and spiritually challenging month.  I would appreciate all of your prayers! There will be Physio department devotions every morning and then a hospital wide chapel once a week. The hospital encourages you to pray with all your patients and talk to them about the Lord's love for them so that will be cool!

Thanks for your interest, support, and encouragement! I really appreciate your prayers and I promise to give reports as frequently as I can while I'm there!