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 ; )