Patient flow

The young girl with the pretty shoe has returned, this time with her papa and grandma. It is the second testing of her new leg.  It takes a while to put it on.

I asked if I could take some pictures. Grandma said no, but the girl, looking for permission from dad, nods yes.  She puts the leg on herself, not yet an easy thing to do. She then walks hesitantly between the two even exercise bars places in the middle of the room.

The motto at this hospital is ‘the patient is the center of our attention.’ It is a slogan but I don’t really see that here. The chief of the center, who is preoccupied with preparing for her trainer’s role later this morning, is not paying much attention to the girl and her father. Maybe I am the center of attention, and pleasing me is what counts. I hope not but it is very possible. I suggest she helps the girl put the prosthetic on correctly, as the first walk did not go well.

The (international) ICRC expert takes a look and shows her how to make the knee lock and unlock on her own. It is all about learning to do things for oneself, he says. Patients are not served if we do things for them. He then watches and corrects her gait and shows how her steps are of uneven length. He draws lines on the floor with a marker to show where her shoes should be at every step, toes one way, heels on the way back. He is very involved with her (the patient in the middle), unlike any of the other staff of the center.  I see that the challenges are not only managerial but also a lack of understanding of what the slogan (focus on patient) really means in terms of one’s behavior. Later I also discover that technical competence to diagnose and treat, is very limited.

Another man comes in, he has diabetes and lost his foot – he is waiting to make a plaster form of his stump but I am told this cannot be done and he has to come back, because Tuesdays are plaster days, not Thursdays. He is accompanied by the only physiotherapist in the hospital; the one whose only staff consists of two blind PT aides. I learn later that all they can really do is massages, as a blind person is of little use to check a person’s gait.

It is busy today because it is market day. In the past there were sometimes only 2 or 3 patients per months. Now I am seeing three all at once. With the help of ICRC the place is taking off. The man for whom the large prosthetic was made shows up and with great ease put on his new leg and walks away to practice outside. He is far ahead of the young girl, making her first awkward steps.

More are coming: a 4 year old girl riding on the back of her mom. She sustained some minor brain damage at birth and walks with difficulty, her foot arches collapsed. The mother gives a small sandal to the assistant. She was told an orthotic would help. My ICRC colleague says she needs PT. Another woman comes with a baby on her back that had his clubfeet corrected. For the next few years he has to sleep with a metal bar with shoes attached that will ensure his bones grow properly. At four years old no one will be able to tell he was born with clubfeet. This is the specialty of CURE hospital here.

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