Amazonas

This weekend I went to search for books about rehabilitation to use as a reference and to help me learn the Spanish vocabulary for rehabilitation. I couldn’t find anything in the stores near my house so I asked a few people I work with where to go. They all said the same thing: “Amazonas”, which is a market in the center of the city. This is where university students can purchase their textbooks and where medical references can be found. When we arrived, we were greeted by stacks and stacks of thousands of books that seemed totally disorganized in various venders’ stalls. We must have asked 20 different people if they had any books about physiotherapy and rehabilitation but all they had were EXTREMELY old (by old I mean publishing date, they were actually brand new books) and outdated books with ancient pictures and diagrams. Unfortunately, I didn't find what I was looking for.

Some of the highlights from this week were:

· “Classes with Professor Carlos (one class about the Spanish words for the cranial nerves and one about ‘Williams’ exercises)
· Working with an 11 month old baby who cannot control his head (he was strangled by the mother’s umbilical cord and has brain damage as a result)
· Learning Spanish vocabulary
· An ‘Actuacion’ (a play put on by all of the children for Mother’s Day)
· Reviewing with the professor the reflexes throughout development
· Soap in the bathroom! (I guess everyone else was as excited as I was, so we are now back to having no soap because it was quickly used up)

Something I find interesting is that many of the assistants as well as the therapists have side businesses to supplement their income. For example, a group of women sell food each day at lunch and another lady sells jewelry and bath products. I don’t know the exact pay for the therapists, but it ranges from s./800 to s./1500 which is approximately $275-500 per month. Although the cost of living here is less than in Canada, this wage is insufficient and it would be almost impossible to provide adequate housing and food for a family. This aspect of life here and what people do to survive sheds some light on how lucky we are in Canada. As Canadians, we complain a lot about health care coverage, the system as well as wages for health care workers, but in comparison to most people in Lima (and other places in the world), we are extremely lucky! !

Here are some shots from the performance the kids did for Mother's Day.

There were 6 different groups who put on a skit or sang a song. Every child was included in this. It was a fantastic day!

Adapting

I have started to adapt which is a little frightening considering what a shock some of the treatments were when I initially arrived. The mothers of the children as well as the other assistants are much more receptive to my presence and as a result I feel more comfortable in asking questions and (attempting to) speak Spanish.

This week has been fantastic because one of the therapists (who is called Professor Carlos) has decided to teach me everything he knows. For this reason, I have seen a wide variety of patients and have been working collaboratively with Professor Carlos to carry out treatments.

In my first journal I said that there are few assessments done on patients. However, I was wrong about that because I saw 3 patients get assessed this week! It seems they are assessed upon arrival at the clinic using the “Millany” assessment which determines the child’s neurological age as well as the course of treatment. In my first week, there were no new patients, therefore I did not see anyone get assessed. He explained the assessment and tested me to make sure I understood, which was great. Something of interest to me, is that you might imagine that there would be a filing system for all of these assessments. ..well there is. They are shoved in no particular oder in a folder inside the therapists personal locker. I really like organization, so for me, this was a shock, but it seems to work for them.

One concern I have is that patient confidentiality at Toñito is virtually nonexistent. Everyone knows everything about everyone else and patients are spoken about loudly in hallways, stairways and in rooms with open doors. I think this is an example of a cultural difference between Canada and Peru that I am learning to become accustomed to. It seems as though in Latin America, the family unit and their involvement in eachother's lives, is given higher importance than protecting privacy and independence. Tonito has a family feel which I like and it seems like no one is trying to keep any information from anyone else.

Some of the interesting things I saw and have done this week are: Traction, ROM on a quadriplegic (scary because their methods of ROM are different than what we have learned as they do it very quickly and force the limbs and as well as extremely quickly as if it’s a race), “Recreation Therapy” (we played outside all morning, there was 1 client and 3 adults…I think it was more for the therapist!), Percussions on a quadriplegic (I only observed this)
I now have a patient of my own (picture on the left) under the therapist's direction. She is a very very cute little girl who is 18 months old, but is only just learning to crawl. We work on core strength, functional tasks like rolling over, sitting up, balance and crawling. I absolutely love working with her and she loves therapy and giggles the whole time.



One major issue that I have is that not all of the children like therapy and some of them are put through these awful, rough therapy sessions and scream the whole time in pain. They will likely never walk, never talk and never be able to feed themselves so why are we trying to rehabilitate them to do so? What are their goals? It seems to me like torture to no benefit to the client and their quality of life is ultimately compromised.

Peru is so different from Canada and it is sometimes difficult to accept new ways of thinking or different ideas about medical treatments or therapies. For example, Professor Carlos and one of the other assistants tried to tell me today that it is very common for a stroke to occur when it’s cold out and this is very often the cause of CVA. I argued, but to no avail. Another example is that transfers are conducted completely contrary to how we were taught in Canada. Therapists at Tonito often drag or carry the kids from point A to point B even if the child could potentially transfer independently or with assistance.

It has also become very clear that the equipment available at Tonito is not up to the standards of a Canadian hospital or rehabilitation facility. Today I was advised to make sure I have the wheelchair brakes on before I move a client. However, as you may have noticed if you watched the video, the wheelchairs are a little worse for wear and the brakes are so rusted and broken that they are totally useless.

One other thing I have observed that is frustrating for me is that patients are also told to crawl and drag themselves along the ground as a form of therapy even though they can walk. I asked why they are practicing to crawl when they can walk and the response was that they practice because they don’t walk properly and also to increase strength. From my training and experience, there are other ways to achieve the goal of increasing strength and correcting gait. However, that is just how things are done here and this gringo is not going to be changing anyone’s mind!

Even though it can be crazy in this place and I don’t necessarily agree with many of the things that go on, I am enjoying it the experience and I find it fascinating. I think the therapist I have been working with does know a lot of useful and interesting information and he loves to teach me, so I am thankful for that.

Below is a picture of a typical wheelchair. Definately a little worse for wear!