Good Bye Belize

This brings me to the end of the amazing time spent in Belize for the past 2 months. Our adventure home included a tiny jumper plane that took us across the country to the main airport in Belize City. I was able to sit directly behind the pilot which was awesome to see everything. From there I took a flight from Belize City to Houston and then from Houston to Newark.

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Our little jumper plane

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Just sitting behind the pilot

I honestly could not have asked for a better experience. All of the staff and crew were amazing. The clinical experience provided me with so much more than I could have expected and the traveling on the weekends was so cool to experience. Thanks to all my friends and family for supporting during this trip. I am so lucky to have been able to experience an adventure as great as this one!

Here are a few photos from the campus of Hillside:

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The outside of my home for the past 2 months

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The Physical Therapy Clinic

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Our work space

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our “private” treatment room

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The giant table in our treatment room

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The medical clinic and pharmacy

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The medical clinic

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The living room

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The kitchen table

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Our family kitchen

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Ignore the mess but this was my room

Until next time Belize! You will definitely be missed!!

Wheelchair Distribution

Today we had a wheelchair distribution day. This was a day where people in PG and the surrounding villages in the Toledo district were able to come out and get a free wheelchair. We had previously measured them all for their chairs and we were going to customize each chair for their specific needs when they got there. This was very exciting since a lot of these people have not been able to have any mobility for their entire life. As expected, the schedule that was made for people to come was not followed. No one was able to come to the location to pick up their chair because they had no way of getting there. To fix this we decided to go pick people up and bring them to the site. There was a church group there from Texas who were helping distribute the chairs so me and the rehab tech Amira went in their car to go get patients while Jonas (my CI) and Joe went in another car. This became a very eventful day. I was educating all the people from Texas about the different ways to transfer people into and out of cars. This was not an easy task since a lot of the patients can’t walk and the van we were using was very high up. I had to explain to the different helpers exactly what to do for each step of the way. This was more difficult than expected because I had to break it down into very basic steps since they had not background in transfers. We ended up picking up 8 people in our van. This allowed me to really nail down my car transfer skills since I transferred them into the car to get to the center, out of the car at the center, into the car to go home, and again at their home. This was about 24 car transfers that I did that day.

Not only was my day filled with car transfers but I also was able to work on sizing wheelchairs for people and adjusting them as needed. We even had to put the wheelchairs together. This is not an easy task at all. I was much happier doing the transfers but that’s just me loving to interact with people rather than reading instructions. At the end of the day we ended up working a much longer day than planned but I was happy to do it. I was learning so much about car transfers and wheelchairs and I was able to see the faces of people who were receiving wheelchairs who have never had a wheelchair or have just been using on that doesn’t actually fit them by any means. This was an awesome event to be a part of.

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Just building a wheelchair

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Walking my favorite patient to her new wheelchair

Weekend #7: Placencia Round 2

For my final weekend in Belize I wanted to do something fun, beachy, and with the group of students who have been here for the past month. This was the first weekend I was able to travel with them. We decided to go to Placencia (again for me). Going back there the second time was even better than the first. The first night was relatively similar to when I first went. We took the water taxi over to the land and then bought some alcohol at the store and had some drinks before going to dinner. We then continued to drink for the rest of the night at various bars that I went to last time I was here. The next morning we woke up and the one student here from London had heard about a place that had a pool overlooking the beach that anyone was allowed to hang out at. At first I thought this was too good to be true. We decided to try it out and see what it exactly was. Let me tell you, I was AMAZED. Basically it was a restaurant with a pool that overlooked the ocean and anyone was allowed to be there. We ended up hanging out there for hours! It was so relaxing and beautiful. At around 5 we decided to head back and get ready for dinner. We went to a different restaurant called the pickled parrot. The atmosphere was really fun. There was live music and a lot of people there. To be honest the food was average but it was still fun. After that we went to another bar and played some games. We ended up staying out late dancing and having a blast. The next morning we woke up and went back to the amazing pool. Turns out on Sundays they have “pool parties”. When we got there the DJ was setting up on the pool deck. The bartender explained that everyone had to spend $10 BZE on Sundays. We all laughed because anywhere else that would be the cover charge to get into the pool let alone if we wanted food or anything. All I had to do was order a sandwich and a drink to hang out at this pool. AND it was hand delivered to be at the pool side. I was not complaining. The music made it way more fun than Saturday and drew in more of a crowd. Sadly we had to leave and go back to hillside that afternoon. Honestly I wish I knew about this place the last time I came! Either way it was an amazing last weekend in Belize. I had so much fun and it is going to make it that much harder to leave this place in a week!

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Potential Need for Standing Frame

Today I went to visit a home health patient. She was a 26 year old female with cerebral palsy. This patient had a lot of spasticity on her right side, especially with elbow extension, knee flexion, ankle plantarflexion, and toe flexion. I started the treatment working on coordination of movements which were very similar to the other patients who have had cerebral palsy that I have previously mentioned. This involved functional tasks such as putting her hair up, bringing her hands to her mouth, and putting the cap back on a pen. Once we were done working on coordination of movements I wanted to work on the spasticity. I decided to start with passive range of motion but then quickly changed my mind and decided to work with pressure support. I started my pressing through her leg onto the ground. Since I had another therapist nearby I decided to try to stand with her. We ended up standing her for 3 minutes with max assist times 2. She was mainly putting her weight on her left foot but this was still a lot more progress than before and it was really helping break up some of the spasticity. We sat her down and stood her again for another 3 minutes. She appeared to love in. As my plan of care I suggested we look into getting her a standing frame. As I have mentioned before these are not easy devices to come by but I feel it will be very beneficial for her to have. I think she would make great progress with this. Hopefully someone crafty enough will be able to make her something suitable for standing!

Follow up with my kidney referral patient

Today I treated a woman I have talked about before. The woman who I have to refer back for kidney issues came back to the clinic. It was amazing to see how much her spirit had changed. She ended up having kidney stones and an enlarged kidney. Once the medics gave her some medicine to help with her pain and improve her kidney function, her pain FINALLY decreased. She has come into our clinic two times and both times her pain was way too high to actual identify where it was stemming from other than the potential problem with her kidney. I was aware that it was either low back or SI joint but that is not very helpful when treating. This time she came back in and I was actually able to identify the specific lumbar vertebrae that the pain was occurring at. I was also able to find exercises that made her pain decrease even more. I ended up sending her home with prone press ups and bird dogs to work on core stabilization. This patient was awesome to experience because you could really see how pain can change the way a person presents. The first time she came in I was very frustrated because every motion I did she was in pain and she was very apathetic during the entire session. This time she was smiling and laughing and very excited to be treated. She was eager to get better and was asking questions about her body. This was great to see because often the patients here don’t ask questions about their pain or diagnosis. She wanted me to explain to her why the pain was happening and what she could do to make it stop. I am excited to see her again to see how much more she has progressed and what else I can do for her.

Snake bite + amputation= Knee pain

Today in clinic I had a very interesting patient referred down to me. He was an 81 year old man coming in with left knee pain. When he came down I quickly discovered why he was having this pain. 40 years ago he had a below the knee amputation because of a snake bite. He has been walking around on his left knee with crutches for 40 years. You can imagine the damage and degeneration that has occurred in his left knee. Right before he came down to the PT gym he was provided with a wheelchair so a lot of our session consisted of wheelchair training for both his family and himself. The son was very involved which was great. I was showing him how to transfer into and out of the chair, how to go up and down a curb, and how to propel the chair in general. I also provided the patient some exercises that he could do for himself from the chair. These were mainly hip strengthening activities since his knee was too painful to move. My goal was to decrease some of the pain and inflammation of the knee now that he is in a wheelchair and then we can gradually work on the knee again. I just found this patient so interesting because I wasn’t expecting a patient to come into an outpatient clinic and have to be taught wheelchair management. I also was not expecting a referral for knee pain to be a man with an amputation due to a snake bite. It was definitely an interesting case to have.

Weekend # 6: Belcampo Restaurant, Belize Zoo, and Blue Hole National Park

This weekend was another weekend where I ventured off on my own because the other students went on a trip that I had already gone on. I decided to stay in PG again on Friday night and I went out to a fancy restaurant at a resort called Belcampo. On the first Friday of every month they have half priced drinks and free appetizers. So naturally I took them up on this option. After the happy hour was over we decided to go over to another local bar and sing karaoke. This was a blast. I think karaoke is more fun in Belize than anywhere else but I could honestly not explain to you why this is.

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The view from the bottom of the stairs at Belcampo Lounge

The next morning I woke up early and took a bus to Belmopan where I met up with another student and we went to the Belize zoo. This was a smaller zoo but VERY cool. There is something about walking around and seeing animals that actually are on the jungles around you compared to the states where you see elephants and giraffes. Obviously I would never run into a giraffe on the streets of Pennsylvania. I got to see Tapirs, toucans, jaguars, spider monkeys, and so much more. Once we were done at the zoo we both got back on the bus and went our separate ways. She went back to the group of students to go on the same trip that they were going on for Sunday.

I decided to go stay at a place called the Yaxche Jungle Camp. This was quite the adventure. I ended up hiking three miles from my bus stop to this place. Once there I realized that I was going to be staying in a campsite with the Mayan family that lived there and no other guests since it is the low season. The owner of the camp was Marcos and he was awesome. He got me all set up and I just hung out in the jungle until it got dark. Then I went and laid in my bunk. A huge storm came in which was awesome to watch because my bunk was covered and protected but I was able to look out and watch the storm around me. In the morning I woke up and ate breakfast with the family. I ended up talking with Marcos for about 2 ½ hours about all these different things. He taught me so much about Belize. I have been in this country for 6 weeks and I don’t think I learned as much about the different culture and events as much as I did from Marcos. It gave me so much of a better understanding of the way things worked. I loved learning so much.

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The bathrooms at Yaxche Jungle Camp

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The path back to my cabin

After we finished talking I packed up my bag and headed out. I decided to walk back 2 miles to a local national park. The park was the Blue Hole National Park. This park included a cave that you were allowed to hike to and go 200 yards into it by yourself without a guide. I decided to start out with this since I have a new found love for caves. It was awesome to be in the cave by myself. After this I decided to go for another hike. The sign said it would take 3 hours but clearly that was wrong since I finished in 50 minutes. I then hiked back over to the actual blue hole which is a large pool of natural blue water. This water was FREEZING and very crowded with tourists. I hung out there for a bit then hiked back up to the entrance, changed my clothes and ate some lunch. In total I hiked about 8 miles that day which was really fun and great exercise. The group of students that went on the other trip picked me up on the way back to PG which made the trip back very nice! All in all it was a great, cheap weekend and very relaxing.

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My view from inside the cave

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The very crowded blue hole

Mobile, home visit, and exploring

Today I went on another mobile clinic. To start the morning off I went to a home health visit to treat a little girl with cerebral palsy. Compared to other individuals in Belize who I have been treating with CP, this patient was very functional. When we arrived she was sitting in her hammock doing her hair. She had athetoid CP which made controlling her arms and legs very difficult. She also was lucky enough to have a standing frame which she was instructed to use daily. This was not the case however. The mother reported that they stood in the frame “sometimes”. In this setting equipment like that is hard to come by and should be used as much as possible if someone is lucky enough to have one. To start the session I transferred her over to the standing frame and she stood for 10 minutes. While she was standing I wanted to distract her while simultaneously working on coordinating her movements. To do this I brought bubbles and a ball to play with. I started by blowing bubbles and making her pop them as she stood. Then we switched it and she was blowing the bubbles while I popped them. Once she was tired of the bubbles we switched over and played catch. After 10 minutes of standing she became tired and wanted to get out of the standing frame. I transferred her back over to a chair and we working on kicking a ball to coordinate the movements of her legs. Her right leg was much more controlled than the left but still needed some work. This case in particular frustrated me a little because in the states a patient with CP and this level of function would be receiving much more care and would potentially be enrolled in a program at school to keep her engaged in the community. Here in Belize she is unable to leave her home and is not getting any form of an education or any social interaction with other peers her age. This combined with the mothers lack of implementing the home exercise program is limiting a lot of the potential I think this young woman has.

Before coming back to the clinic site to continue treating I decided to explore a little bit around the village. I quickly found a river and a cool bridge that crossed over it. I also found a group of woman doing their washing in the river.

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Working very hard as you can tell

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The woman washing in the river

Back at the clinic site I co-treated a patient with another PA student again. In her chart her age was written as 90s? because the woman was completely unaware of how old she was but suspected that she was in her 90s. This woman had pain EVERYWHERE. Low back, upper back, headaches, abdominal, bilateral knees, and hips. Initial hearing this I assumed she had a large amount of osteoarthritis which is common with age but that was not the case. Since there was abdominal pain, the PA student started her screen first. She quickly found two large masses in her stomach. The supervising doctor stepped in to examine the patient’s stomach and we quickly recognized that she had two large tumors in her stomach. This was very upsetting because at her age and her village location, there is little treatment that can be done for her suspected cancer. Obviously this finding prevented me from continuing my evaluation since cancer is a clear contraindication for a lot of physical therapy activities. Instead I discusses with my supervising therapist the options of providing her activities to do that would both keep her from regressing more as well as keep her spirits high. She was crying during the entire session and appeared to be unable to make smile. At one point she told me (through translation since she spoke kekchi) that she wished should would just die. Being the person that I am I decided this was not how the treatment session was going to go. Instead I decided to find a way to lift her spirits. I was providing her exercises and was attempting to speak the little kekchi that I know. We were doing the basic task of extending her knee and lifting her leg and putting it back down (LAQs combined with a seated march). In this setting the patients understand the task by saying “taxi” which means lift and “coopsi” which means down. I started to slowly pick up the pace that I was saying these two words making her kick her leg up and down at a very fast pace and before I knew it she was laughing out loud and smiling. As you can imagine it is hard to make someone laugh after they just received the news that they have cancer and there is not treatment to help them at this point. It was great to be able to find a way to keep her spirits up and keep her laughing.

Extremely Far Away Mobile

Today at clinic I was on another mobile clinic. To start this was a very far away clinic and you spend 2 hours on a bumpy road that can’t be good for anyone’s spine. But not exactly the point.

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Patiently waiting for my patients to arrive in my private treatment room

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The Physician Assistant treatment area–not working with much here as you can see

The first patient I tried to see was a female who had cervical neck pain and headaches. I tried to do my interview with the patient and she appeared very hesitant. Once I asked her to start actually moving she denied me completely. I tried my hardest to convince her that there was so much I could do to help her with her pain and that she could be in control of some of her aches but she refused. All she wanted was some ibuprofen for the pain. This was extremely frustrating as you can imagine. I couldn’t force her to let me evaluate her so all I could do was walk away. This was not fun.

The next few patients were way different though. I had one woman who had cervical pain because she was carrying heavy objects on her head for hours at a time. Imagine carrying a bucket of water on your head. Obviously the neck pain was going to happen. As I evaluated her she was very interested in my treatment. This is rare especially in the villages. The villages usually have people who only speak Kekchi and they are usually unwilling to listen to my suggestions and help. This was exciting though because she allowed me to show her different activities and seemed very excited to follow her home exercise program. Every time I bring out a cohune nut (a nut from the trees here that is hard) and give it to a patient as a personal massage tool to get knots out of their back and to break up some tissue, they all just laugh at me. It works so well and they enjoy it but they all laugh at how I am making them rub a piece of a tree all over their muscles. I also tried to use some of the Kekchi lingo that I have picked up from listening to my translators. This is something that everyone laughs at. I clearly am not saying anything correctly but hey whatever I am trying. That should count for something!

I finished the day off with a patient similar to the one I started with. He had low back pain and was eager to get some medicine. When I examined him I quickly learned that he lifted heavy objects in the fields all day long and he was constantly bending at his back rather than his knees. This can cause so much pain and damage to someone if they do it constantly. When I tried to demonstrate to him how to properly lift up heavy objects he blatantly told me that he has been doing it his was his entire life and he doesn’t plan on changing that. Once again I tried my best to explain how it was bad for his back and that he was causing his own pain but he refused to listen. In the end I basically asked him to try to lift the proper way for one week and if he can do that than he might start to feel some improvements. I am not sure if he will listen but it was the best I could do for a non-adherent patient.

 

Weekend #5: Hopkins, Mango Festival, and Mayflower Bacowina National Park

This weekend there was a new group of students at Hillside. With this being said most people like to go on the first three trips that I went on when they come here. So this weekend I had to fend for myself. I decided to stay in PG on Friday night because my new roommate was celebrating her birthday. We went out to a nice restaurant on the water front and had some drinks. This night was a lot of fun. The next morning I woke up and caught a bus up to Hopkins. This is a small Garifuna village about 3 ½ hours away from PG. There was a big mango festival going on so I figured it would be cool to check that out. Another guy who came on this rotation decided to come with me rather than go with everyone else to Lime Caye (the island I went to before). Worked out for me because I didn’t have to travel alone! We ended up getting to Hopkins REALLY early so we checked into our hostel and went down to the beach for the morning. It was beautiful. The wind was blowing so there were ZERO sand flies. I got to lay on a hammock under two palm trees and just look out over the ocean. In the afternoon we wandered down to the festival where there were mangos EVERYWHERE. I indulged myself in a delicious mango shake up drink where the man literally smashed a mango into my cup and then shook it really fast as he added other ingredients. It was delicious let me tell you. Super refreshing. I also wandered over and got myself a really good mango pulled pork sand which where they make the barbecue sauce with mangos. Also delicious. After we hung out at the festival and found ourselves the beer tent for a few hours we went back to the hostel to shower. Then we wandered upstairs to a local bar above our hostel. This was fun because a bunch of people from Canada came up there and we all chatted a bit. Then a Garifuna man came up and decided to serenade us with his guitar; granted I egged him on. He was so funny though. Definitely some natural Belizean entertainment.

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Hopkins Beach

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Walking into Mango Fest ready to eat some fresh mangos!

The next morning we woke up early and planned to go to Mayflower Bacowina National Park to go hiking up a big trail there. Little did we know it would be EXTREMELY difficult to get there. We ended up walking 3 miles before catching a ride to a junction. At the junction we called a cab and he charged us way more than he should have but whatever. We got there and we were excited. Of course stupid me let the battery on my go pro die before the hike (kicking myself for this because it was beautiful). As we started up the mountain it was flat(ish) land followed by step like surfaces and then came the steep part. This part was equipped with ropes to help pull you up because it was so steep. This made the hike way more fun. I was exhausted by the time we reached the top but it was well worth it. First there was this amazing look out that went over the top of the falls. It was beautiful. Then up a little farther there was a “pool”. This was something from a movie. There was a water fall that fell down into a small pool of water that you could swim in and jump off the cliff. It was like ice cold (RARE here in Belize) and it felt amazing. We ended up hanging around there for about an hour just swimming and relaxing and jumping off the cliff. Then we decided to trot back down this steep mountain. A lot easier to get down than up to be honest. Probably helped that we were able to use to ropes to basically repel ourselves down. Once we were down we called our expensive cab driver and had him take us back to the bus station to catch our bus back to PG. It was definitely a weekend I would suggest to anyone. It was cheap and super fun. Also I was ecstatic that I finally got to hike in the jungle and experience all of that. Once we got back to PG we wandered over to our friend Jamie (one of the workers at hillside’s) football game and watched him play. All in all amazing weekend!

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This is the road we walked for 3 miles before we finally got a ride. Literally nothing to be found.

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The start of our hike!!

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one of the ropes to climb the steep parts

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Antelope Falls

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The view from the top of the hike before we hit the pool

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The amazing pool at the top of the waterfall