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.
This is the building we did our mobile in today
This is one of the rooms I was doing my co-treatments in with the PA students
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.
Shes only cringing because of the sun I promise she wasn’t in that much pain I am not that mean of a therapist 😀
Today I worked in the OPC in the morning again. The first patient I had was a little boy who fractured his tibia. He started off the session very shy as most kids do but gradually he became more comfortable with me as his therapist. We started off the session with him showing me all the exercises he is supposed to be doing at home. These included: side planks, side lying hip abduction, calf raises, and supine bridges. We then moved on to incorporate new activities in the session. Working with kids can be either really difficult to keep them engaged or really easy. This boy in particular was very easy. Since his ankle and lower extremity in general was unstable, I decided to work on some activities that would work on balance and stability. The first activity we did was passing a soccer ball (football as they call it here in Belize) back and forth. I made sure that he was stopping the ball with one foot and passing it back with the other. This required him to perform single leg stance dynamically with both legs which worked on stability. Once he became tired of this we switched over and decided to play catch. To incorporate balance I had the patient stand on a dynadisc and balance while throwing the ball to him. This task appeared to be difficult for him as he kept falling off the disc. It is very exciting to see a patient happy to be involved in therapy, especially in Belize. This boy was excited to play with these activities and his father was watching the entire time and could see his progress. After the session I was talking to the father and he appeared very happy with the progress his son was showing and he made it clear that he makes sure his son does his exercises at home. No matter what country you are in it is often hard to get people to do their exercises at home on their own. This is a very important aspect of therapy here in Belize since we only see these patients every 2 weeks. If they don’t perform their exercises daily there can be limited progress overall.
This weekend was a weekend where the first group of people I have been living with left and the new group came in. It also happened to be a weekend called Chocolate Fest in Punta Gorda. This worked perfectly for me because I was planning on staying in PG to say goodbye to some friends and say hello to new ones. Friday night I went out to a local restaurant in PG and had some drinks and food with two of the girls that left the next day. When we got back the girls wanted to go to sleep early for their busy day of traveling the next day. I on the other hand wanted to stay up and be social so I walked down to one of the hillside worker, Jamie’s house. He was hanging out with a few of his friends in his front yard drinking in a boat. Literally just a boat on land in his front yard. So I jumped on in and hung out for a few hours before I walked back up to the clinic for sleep. The next morning I woke up early and went into town to experience the chocolate festival. I started with a breakfast at my favorite place called the snack shack. I have chocolate banana pancakes. Amazing. Then I wandered around town. This was interesting because besides for my breakfast there really wasn’t all that much chocolate at this festival. It was more just people selling things at different booths. So I hung out there for a few hours then headed back to the clinic for lunch. At around 3 some of the new people arrived and we all hung out until dinner. I took them into town to a little restaurant where you can get fried chicken, beans, and fry jacks for 6 BZE (3 US). Then we walked over and ate it on a local dock overlooking the water. Since this group traveled a lot that day we went back to the clinic after that so they could get some rest. When we got back there were even more new students here. The next morning we woke up and biked into town again so I could give them a little tour. We ended up getting two flat tires out of the 11 people we had biking. One of those was my bike. So as you normally would do in Belize, I dropped the two bikes off at a local restaurant that knows us so they wouldn’t get stolen. Then I directed everyone who had a bike to go to a nearby dock to go swimming. Me and the other person who also got a flat hitch hiked over to the docks and swam until someone could come pick us up. Worked in our favor because we ended up stopping for food on the way back while everyone else had to bike back the 6 miles. In the afternoon we took a bus over to the closing ceremonies of the chocolate festival. This was basically just a bunch of soccer games followed by fireworks. Still very fun and entertaining. It was an awesome weekend to spend in PG because it gave me a chance to meet all my new roommates and really explore the town more.
Today we went out to a school to do a disability awareness program again. This school was special though. It was on a beach called Punta Negra. We had to take a boat out there in order to teach our lesson. I was perfectly happy with this work day. We went down to the dock early and got picked up by a Belize man named Asha. He is the cook at an amazing restaurant in town and he is so friendly. He took us out to the island on his boat. He volunteered to do it because this was the island he grew up on and we were going to the school that he once attended. The boat ride out was beautiful. We “think” we saw a manatee but to be honest I have no idea what I was looking at I just pretended to have seen it. When we got to the land I was amazed. It was beautiful! I can’t even imagine living on a place like this. We went into the school and they had put together a little performance for us. I don’t think they get many visitors so they were extremely excited! After the performance we gave our presentation. When we were done we went outside and played with the kids for a little while. We played catch with one hand as if they had a broken arm. Then we played football (soccer) with one foot as if they had a broken foot. After we played for about an hour we said goodbye and wandered over to Asha’s aunt restaurant for lunch. She made us an amazing meal. I got to spend some time talking to Asha about his life in Belize and I was in hysterics. He is a hilarious man and so much fun to talk to. He was cracking so many jokes. Then he walked over and cut me down a coconut so I could try the coconut water. It was delicious. Never had a coconut before but there is way too much liquid in those things for one person to drink in one sitting. When we were done in Punta Negra, we got back on the boat and went around the ocean some more. Asha took us down a part of the ocean sort of like a river that was supposed to have a bunch of alligators but we didn’t end up seeing any. This was probably the best “work day” I have had in forever.
The boat ride to Punta Negra
The view from where we ate lunch
The PT crew and the children from the school
Me and my new best friend Asha
Today I went on another mobile clinic. One patient I had today was experiencing back pain in her thoracic region. As I did my evaluation I discovered she was very hypomobile in her thoracic spine. In any other setting I would be seeing this patient 2-3 times per week. This would allow for me to do some mobilizations to her thoracic spine to help improve her range of motion. In Belize that is not the case; especially on mobiles. We only see these patients once every 2-3 months. This makes treating someone like this patient difficult because ideally I want to help her improve her range. Instead I have to provide her with some self-mobilization techniques that she would have to do on her own. The issue with her spine was she had decreased thoracic extension all throughout her thoracic region. I had her sit in a chair and do self-mobs over the back of the chair. She was advised to line up the level of the spine that she had pain with the chair and do the mobilization there. This is hard enough to explain to someone in the United States, let alone a woman who doesn’t speak English and lives in a village where they don’t have any idea what physical therapy does. Finally she began to understand what I was trying to have her do. Hopefully she continues to do this on her own to help decrease her pain and improve her range.
Once I was done treating this patient the med team came up to treat her with a pelvic floor exam. She had with her a 2 month old baby and a 2 year old baby. As the med team arrived she quickly handed me the baby and left me in a room with her two children. I looked at this in two ways: 1. She trusted me enough after our examination to watch her kids during her exam, and 2. She was happy to get them off her hands because the 2 year old would NOT stop crying. I had the 2 month old in my arms sleeping as I am trying to entertain this 2 year old boy who was just not having it. Finally someone else came up and helped calm the 2 year old while I hung out with the 2 month old for about a half hour. My preceptor kept laughing at me because whenever he came upstairs I was still playing with the baby rather than actually working on my own patients. Whoops. But he was so darn cute I wanted to steal him away. Not the 2 year old though. He was not so cute but more on the evil side.
My PT table and station set up and ready to go
All of the pharmacy meds we bring to the villages
Tonight we had another cultural night that was planned for us by the Hillside staff. We went to a drumming school in PG. This was a Garifuna family who owned and ran this school. They teach people how to drum to different Garifuna music. We got there and listened to the family play their songs for about a half hour. Then we all got up and learned how to do the dance called the Punta. This is basically a dance where you wiggle your hips as fast as you can. It was so much fun. We were all dancing and laughing while this family played this amazing music on the drums. After we got to play around with the drums and dance to the music they made us original Garifuna dinner. It was Hudut which is basically a piece of fish in this delicious saucy soup and mashed plantain on the side. It was amazing honestly. The night ended up being so much fun and we all loved listening to the music. It was definitely a cultural experience that involved the natural lifestyle of the Garifuna people.
Ray letting each of us try the drum
The family playing for us
Today I had a patient come in who consistently has too high of blood pressure. When she came in last time I referred her back up to the clinic because she explained to me that her doctors told her to take her BP meds every night before bed which is strange. Normally they are taken in the morning. The med students ended up increasing her dosage for her medication and explained that she is not compliant with medication so her taking it at night was the only option to make her remember to do it. This time when she came in as I interviewed her she explained that she took her BP meds last night with some Tylenol because she had a headache. She then went on to tell me that she woke up and still had a headache. So to fix this issue she decided to take her BP meds again. This is one of those cases where it is hard not to laugh to yourself for not recognizing that the patient actually has no idea what her meds are for. I quickly explained that BP meds are not used to decrease pain but instead to help maintain your heart at a healthy level. This information appeared to be brand new to the patient. This was great practice for me as well because explaining medications is hard for me since it is not exactly my job to administer and dose meds. But physical therapists are the only medical personnel that most patients spend the most time with. So we often have to explain to them what they are taking and what is going on with their body and diagnosis. Needless to say this patient needed some serious medication counseling because she was unaware of what she was putting into her body and what it was for.
Today I also had a patient who came to clinic with low back pain and abdominal pain. This was an initial evaluation so I was doing a full exam on her. As I started my exam I was suspecting some SI joint pain and problems. She appeared to be in pain everywhere. She then began to explain to me that the pain was mainly in her stomach and back. I decided to do a visceral screen to make sure there was nothing else going on. Well it turns out that she was positive for a lot of my visceral tests. I started to think that the issue could be both SI Joint and kidney related. In this case the pain of her SI joint was too acute for us to do anything anyways because her pain levels were too high and everything was appearing positive. At this point in my evaluation I discussed with my preceptor that I was not sure how comfortable I was continuing to treat this patient when she has positive signs for kidney problems. He agreed with me and we referred her back up to the medical clinic. This was interesting for me because I have never really had to refer a patient back to the medical clinic besides for simple medicine issues. I was excited that I caught something in my evaluation and exam that could be problematic for this particular patient.
This weekend we went to our own private island called Lyme Caye. We left Saturday morning around 7 am on a boat with our tour guides Kenny and Ray. They took us out on a boat for a 1.5 hour boat ride to the island. Once on the island we went off to put our stuff down in our dorm style rooms. The woman who lives on the island had breakfast ready for us. She made us eggs and bacon and fry jacks with a special jam that was to die for. After breakfast we went out on our first snorkeling trip. This was AMAZING. Ray got in the water with us and was pointing out all the fish that we didn’t know (which was pretty much all of them except when I saw a Dory fish.. I knew that one). We got to see barracuda, lionfish, eagle rays, and I even saw a nurse shark! It was incredible. After our morning snorkel we went back to the island where lunch was waiting for us. After lunch we got some time to lay around the beach and relax. It was so beautiful I can’t even put it into words. At around 2:30 we went back out for our second snorkeling trip. This time I was getting better at recognizing the different fish that I was seeing. We even saw dolphins and got to snorkel in the water near them! After an hour of snorkeling we came back and quickly went back out to go fishing for our dinner. We did a type of fishing called trolling which is where you just leave the line in the water and drive the boat around. Apparently the bigger fish think the bait is desperately swimming away from them. At this point the water was getting really choppy and we were on a small boat in the middle of an ocean. We fished for a little while and only caught one fish. It was a pretty big grouper though which was cool. Finally our boat driver Kenny decided it was getting too rough and we would have to go back in. I was sad I didn’t get to catch us our dinner but it was still awesome to get to try. Back on the island the one grouper we caught was cooked up and we started to pour some drinks. We all just hung out and relaxed on the island all night. When it got dark the whole island became covered with hermit crabs. Literally they were everywhere. We decided to have a hermit crab race which was hilarious. At the end of the night I couldn’t get myself to go to sleep in a dorm room when I had the beautiful ocean breeze and open sky above me so I slept outside on a beach chair on the porch of our dorm hut. Best decision ever because I got to look out at the stars while falling asleep and I got to watch the sunrise from my bed in the morning. Once everyone woke up we went down and met Ray on the beach. We went out on the boat to try to fish again in the morning. I must be bad luck because once again we didn’t catch anything. Ray explained that sometimes they come back with a boat full of fish and sometimes nothing so we just had bad luck I guess. Back at the island we ate breakfast and then learned how to spear fish. We were on a mission to spear some lion fish. We took off on our last snorkeling trip around 10 am. This time we snorkeled over a shipwreck. This was SO COOL. It is crazy how the reef just grows on the wreck since it has been there for so long. It definitely makes you wonder the story behind that particular wreck. After our last snorkel we went back to the island and hung out for a few hours in the sun. At around 3 we got all of our stuff and went back on the boat to leave the island. It was an amazing trip. I would go back in a second if I could.
Our boat for the weekend with our driver Kenny and our snorkeling guide Ray
This is the building that we were sleeping in on the island
The beds/ dorm on the island
view from my hut
The view of our beach
Just hanging out on an island in the middle of the Caribbean
After clinic today we had a cultural lecture on how lepobs and machetes are used. A lepob is a cotton sheet that is wrapped around the head and used to carry babies up to the age of 5. Imagine carrying a 5 year old child in a bag on your head with just you neck muscles. This explains why a lot of my patients have neck pain and headaches. She also lectured us on how machetes are used in the fields by the men. They could be working in the field for 10 hours non-stop using a machete. That is a lot of repetitive motion that they are doing. Once she finished her lecture she gave us all bleach bottles and told us they would be our babies. We then each took a lepob and carried our babies on our heads while we walked about half a mile up a hill.
Me and Joe carrying our babies in our Lepobs
Once we were at the top of the hill we took off the lepobs and started to use the machetes. Watching how men do this in the villages explains a lot about why they all have low back pain. Not only is the repetitive movement bad for the wrist, shoulder, and upper extremity, but it I also putting a huge strain on the back musculature. Not to mention the body mechanics during this activity are VERY poor. Once we were done this we started to head back to the clinic. I decided that I wanted to combine the two gender roles and I attempted to use a machete while carrying my baby in a lepob. This was not an easy task but it was hilarious to try. It is amazing how this is the standard in their culture. We look at it as if it is so strange because it so clearly causes a lot of issues to your body but this is how they have lived for generations.
This is me working the machete like a boss
Me attempting to machete while using a lepob
This week we had some time to be adventurous when we were done clinic. There is a local couple who lives here and they have an AMAZING infinity pool that overlooks the jungle. The couple loves Hillside students and they let us come over and swim in their pool if we ever call and ask to stop by. Me and two other guys on the trip decided to get on our bikes and bike down to their house about a mile away from our clinic. When we found their driveway we had to stop and admire their land. They have this long strip of a driveway that is lined with palm trees all the way down to their house. As we rode our bikes down the driveway there was field of cattle on the one side of us. They started to trot next to us as we biked up to the house. Once we got to their house the couple was standing outside cleaning off their dogs. After talking to them for a few minutes they took us around back to show us the pool. The view is amazing. It is almost as if we were staying at a fancy resort somewhere. The infinity pool overlooks the jungle and they maintain the land so well. We got in the water and swam around for a bit. It was so relaxing and refreshing after a long hot day at work. It is so nice that these men let us come and use their pool whenever we need to cool off.
The Driveway Entrance
The view from the front of the pool
The view from the side of the pool