All Work and No Play

I've been neglecting my blogging duties yet again. COPE is hosting an Indochina Regional Conference on Club Foot and Cerebral Palsy from Sept 3-7th and we're in full organizational mode currently. It's amazing how much logistical organization and work goes into something like this. It's a great experience, good for the resume and eye opening in a lot of ways. I definitely have a new appreciation for all those national conferences I attend for prosthetics and orthotics.

Sengkham, our local orthotist, is well practiced in the method.

Just this morning we had a minor snafu when the issue of MC came into play. Our Lao National CEO was supposed to play the role but due to logistical and political issues, she has decided not to. So, as it turns out, my Lao counterpart and I are taking on the duty. Not such a big deal, other than now I have to look more put together and less stressed. I was hoping to be a "behind the scenes" person who could look frazzled and a little on edge and no one would notice or care. Oh well.

An example of how repeated casting corrects clubfoot, without surgery.

It's an exciting even in that we are bringing delegates from Vietnam, Cambodia, Myanmar, and Bangladesh. We're hosting it in conjunction with ISPO (International Society of Prosthetics and Orthotics), who provide the international expertise. We're responsible for all the logistics.....I'm pretty sure ISPO is getting off easy with this arrangement. :)

The course will be ran over five days. The first day will be opened by the Lao Vice Minister of Health and the US Ambassador, and is basically a regional meeting to allow people to share their techniques for implementing systems and protocols for treating clubfoot in low income countries. Lots of discussion about the Ponseti Method and surgical intervention of untreated clubfeet. It's a really interesting topic, and worth reading about. Amazing how debilitating neglected clubfeet can be and the treatment is relatively simple and easy if done as an infant.

Locally made brace for clubfoot, the Steenbeek

 brace.

The next two days of the course are lectures by the ISPO experts on Cerebral Palsy, which is an extremely complex topic and one that is controversial, even in western countries. Then the last two days, we seperate the participants out into three groups to assess patients, cast for braces, etc.

All in all, a ton of work and prep but hopefully will be a good learning experience for everyone involved. And luckily, Ian and Saleema are arriving the following Sunday! They'll spend a few days with me in Lao and then we'll all head to some amazing Thai islands for much needed lounging, sunbathing and general debauchery!!!! 

A sweet little boy with neglected clubfoot. Imagine having feet that are painful and difficult to walk on, such a debilitating deformity.

Photo for the Fridge

The official American Embassy photo of Hillary's visit to COPE. Putting this one on the fridge for sure. :)

It's raining frogs and bicycles

I've finally embraced the idea using a bicycle as my form of transport. Unfortunately, I made this decision right before our biggest rain storm of the year. So I'm a bit soggy in the shorts currently but happily so, as at least it's a welcome change from unrelenting heat.

The way I see it, having commuted via bicycle in Lao, I can do it anywhere. Don't get me wrong, the ride  isn't at all physically taxing, it's almost entirely flat and aside from the heat, you'd hardly break a sweat. Alas, its the rest of the people on the road in Lao that make biking a daily adventure.

I feel like I need to be decked out in combat gear every time I head down my driveway on my cute little  mountain bike. When I pull up a stop light surrounded by motorbikes, I can't help but feel a little like I should be revving my own engine. Instead I take a big inhale of exhaust fumes and try my best to stay out of every one's way.

However, Lao drivers haven't yet discovered the rear view mirror, with a mentality that only that which is in front of them matters. So I'm adopting a defensive biking method than entails holding on and praying I don't get rear ended.

I went to the gym today after work to go for a run. I went to the locker room and changed into my workout clothes and tennis shoes. I noticed one tennis shoe seemed to have a bit of a wrinkle in the foot orthotic. So I went and used the toilet and when the foot orthotic was still not right, I took of my shoe to readjust. I slipped my hand inside to smooth out the insole and felt a squishy, slippery little body. I screamed, jumped and tried to convince myself I wasn't hallucinating.

I peaked into the shoe and peaking back at me, looking a little dazed and smooshed was a substantial little frog. Poor little guy looked just as upset as I was, and I can only imagine how his poor little squishy body was feeling. So I took my little buddy outside and dumped in the rain. He didn't hop off to quickly but was gone when I left the gym an hour later.....so I hope he's tucked away in some little hiddyhole, somewhere recovering.

This little froggy was not so lucky as the one I encountered. Not a good substitute for padding in a prosthetic socket.

Hard at Work

Work has been good lately. The last few weeks, things have picked up quite a bit, and I feel like I'm getting to make much more of an impact.

Fitting a handmade Giv Mohr sling. The P&Os were really excited about the possibility of using this sling for the many stroke patients they see.

I held a training last week to train the staff in the fabrication of two new devices and the method of serial casting. There is a ton of work that goes into creating a five day training from scratch so it's nice to feel like it's worth it. I feel like I'm starting to bond a little bit with my Lao P&Os which makes it much more enjoyable.

The training was structured so that the first three days, I worked with the P&Os lecturing on diagnoses, theory, and fabrication. Then the last two days of the course, their bench technicians came and worked with the P&Os to actually fabricate the devices. The idea is that the P&Os will gain a better understanding if they have to teach it to someone else, and hopefully it will promote teamwork, which from what I've been told is a problem, especially in the provinces.

Fitting a handmade Pavlik Harness. This is less likely to be used often, due to the fact that babies are NOT normally tested for developmental dysplasia of the hip (DDH). We hope to change that by educating the midwives, as we have about clubfoot and the Ponseti method.

I really enjoyed the training, although it's quite exhausting to lecture for five days. Luckily, I only have to do it a couple times a year. This training taught the staff to make a Giv Mohr sling, which is an upper extremity device for patients after a stroke. It helps support a flaccid arm, improves balance, prevents shoulder subluxation, and helps with gait symmetry. They also learned about the Pavlik Harness, which is a device babies are fit with if their hips are not forming correctly. The difficult part of this is getting the doctors to diagnose the hip problem. Currently, babies aren't screened for it and I've already had a couple cases where older children get xrays and have obvious DDH. Past a certain age, this becomes a surgical issue and one that we don't have the capacity to deal with, no it goes untreated.

Aside from our training course, I've also had the chance to see a couple of patients over the last few weeks. That's always fun and makes me realize how much I miss that part of my profession. Most of the patients I've been seeing are children, which I really enjoy. Although many of them have a strong aversion to foreigners and scream bloody murder when I come in the room.

I have been following up with a little boy (6 months) who was born without patellas and with extreme laxity in both his knees. So whenever he fully extends them, they dislocate. It's pretty painful to watch, although he doesn't seem to experience any pain. I've been talking with an orthopod in the UK but am really unsure what I can do.

This was her at 6 months.

The latest idea is to put him in some very simple long leg braces without any joints that hold him in about 80 degrees of knee flexion. So he won't be constantly dislocating his knees. Then hopefully the orthopod visiting in Sept. can take a look and see if there is any surgery that can be done. Not a great success story but a super sweet little boy with great parents.

Now an active, intelligent two year old.

I also got to see an adorable little two year old girl, who was terrified of foreigners. She apparently suffered a bilateral brachial plexus injury at birth. Without any intervention, her right upper extremity has improved dramatically and she almost has full function, minus a couple of flexed fingers. On her left, however, she has a flaccid wrist and hand, a 20 degree elbow flexion contracture and limited motion of her shoulder.

She does quite well, making do with what she has. But I made her a low temperature WHO (wrist hand orthosis) to try and stabilize her left wrist so she can use that hand as a support for bi manual activities. She tolerated it surprisingly well and hopefully will follow-up with OT and I'll get to see how she's doing. She sure wasn't happy to have me around, but she definitely made my day!