Today I went on another mobile clinic to a village where it is very common to carry buckets of water on the woman’s head. As you might have guessed, I had multiple patients coming in with headaches and neck pain. This mobile went very well because the new PA students pulled in the PT students right when they read the file that said anything with pain. This allowed for us to participate in the interview and decide whether or not we felt the patient was suitable for PT. This also helped us avoid asking the patients the same questions 5 different times. A lot of my patients were similar at this mobile. The one patient I had came in with neck pain. I evaluated her and determined that she had a hypomobility in her cervical spine. For this type of setting it is difficult to suggest mobilizations for hypomobilities because we are only visiting the villages once every 3 months. Instead I decided to focus my treatment on correcting her posture and educating her on why her pain was occurring. We started off with chin tuck exercises which are surprisingly very difficult to describe to a patient. Then we worked on scapular retractions to pull the shoulder blades back and realign the patients posture. The patient also had very tight upper traps and trigger points were palpable throughout the supraspinatus and rhomboids. To help with this I provided the patient the cohune nut massage that I have mentioned before. This way she could do the exercises on her own and didn’t require someone else to help massage out the muscles. Patient education is huge in this setting. I explained how after carrying buckets of water on her head she needs to perform active range of motion in all directions for the cervical region to decrease some stiffness. It is frustrating that in this culture it is so common for people to carry things on their head and we can’t tell them to stop. Instead we just have to give them other options to decrease their pain.
I also went on a home visit in this village. This patient was a 90 year old woman who was living alone in a small house. She had general weakness of her lower extremities and was unable to perform very many functional tasks independently. When I visited her she was laying in her hammock. I started the session with basic motions while sitting in the hammock. In the beginning of this rotation I would always laugh when I was working with patients in their hammock but now I enjoy it because it adds an additional balance challenge to my patient while they perform their exercises. Once we warmed up we went for a walk. Once standing I quickly realized that she has not walked outside of her house for a few days because she was afraid to fall. This gave me even more incentive to walk her outside. Although we only made it a few feet outside her home due to the heat once outside, it was exciting to see her up and moving. This was a case that was sad to see because it was clear that she was slowly regressing and there was not much that one session every 3 months would be doing to help her.