Physical therapy at Kijabe

I thought it was about time to write about the work that I am doing in the hospital with Physical Therapy. In general, the hospital is setup by men’s, women’s, pediatric, ICU, private, and maternity wards. Only in the private ward do patients have their own rooms and nursing call lights. Within the individual ward’s there are 5-6 rooms, 20ftx20ft each. Within each room there is an average of 10 patient beds, a hanging sheet is the only thing that creates privacy within these rooms. The pediatric ward is separately funded from outside the hospital, so the patients have twice the space, but our area to practice pediatric physical therapy is in a large tent outside (It gets extremely hot during the day).
Overall, the hospital has a staff of 4 Kenyan trained PTs, 1 American PT, and 2 technicians. These 6 have the responsibility of all inpatient wards, outpatient, and weekly clinics (hand, ortho, and pediatric). Sherri Letchford, the American Trained DPT, is my instructor and our daily routine has never been normal. We are not sent to specific wards or clinics to see patients, but float where ever they need out help. This week and next week will be specifically working in the pediatric wards with club foot deformities, hydrocephalus, and spina bifida. Kijabe Hospital has been privileged to have Dr. Albright, an internationally known pediatric neurosurgeon, here for the past 3 weeks. He has specifically been working on the hydrocephalus, spina bifida, cerebral palsy, and neurological deformities. I was able to spend a day in his theater (Kenyan name for operating room) watching shunt placement, ETV (endoscope third ventricularotomy), and myeleomengiocele closures.
(A side note with the surgeries…) The Operating Room conditions are NOTHING like what we consider normal in America. Here they work with what they have, and never do you hear a surgeon complain about not having the appropriate instrument, drugs, or conditions. In fact…my job as an observer was ‘the fly swatter.’ Yes, during neuro surgery I was in charge of swatting the flies in the room. One last comment, prior to each surgery, everyone in the operating room stops and a quick prayer is spoken for the operation and patient.
…back to PT….I don’t want this blog to go too long, so I’m sure I’ll be sending out weekly PT updates. For now, here is one story:
Kenya has been in seeing a rapid increase in Rickets, a vitamin D deficiency, in children around 6mo to 3 yrs old. This trend has been caused by a cheap porridge mothers feed their children. This porridge advertizes “flour mix” making mothers think they are providing a well balanced porridge for their child. However, this mix contains legumes. Legumes produce phyates, an anti-binding factor that does not allow iron, zinc, or calcium to absorb. Without the absorption of these minerals vitamin D can not be produced, thereby Rickets is the end factor. Their bones become very weak, and they lose muscle function and strength. This can be reversed, depending on when they catch it and the severity of the deficiency. Children are placed on high dosages of calcium for 1 month and physical therapy is recommended. The two cases we are working with, both children are 15 months old, have lost the ability to walk, roll, and can only lift their heads for brief periods of time, due to neck musculature weakness (this leads to feeding problems). We are early on in the rehabilitation process, but usually they begin to regain function within 6months, with mild developmental delay. The sad thing is, the specific porridge that has been shown to cause Rickets is still on most shelves in the market, and the education is done only after admission to the hospital.