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!