It is good to be doing physio work again. I have always enjoyed the privilege of being able to get alongside and help people who are going through tough times and it is nice to get back into that. However there are certainly many differences to physio as I’ve known it.
At the moment it seems as though I am going to be based out on the wards. (The other two physios seem to be mainly based in the outpatient and emergency departments). So I have spent my first few working days making myself known on the Surgical, Medical and Paediatric wards and trying to find some patients. I say trying to find, as it seems that because the physio service has been so limited, the nurses and doctors are not used to being able to having much access to the service and are unsure who will be suitable to refer. However slowly the information seems to be creeping out. So far I have seen patients with Spinal Cord Injury, Head Injuries and strokes, all ones that I am used to treating although the setting and lack of equipment mean that my treatment approach has had to change.
I have also had a number of patients with burns and respiratory problems and children with neuro development problems and amputations. It is a challenge to refresh my memory back to my training as I haven’t worked in these areas for many years.
For those physios (and other healthcare professionals) who are reading this. Here are some of the new questions I am facing:
How do you work with a burns patient who has developed multiple contractures due to not having any physio for a couple of months post injury?
How do you treat the spinal cord injury patient who has not had his neck stabilised as is still on the surgical waiting list (1 month post injury)?
How do you treat the unconscious patient with sputum retention when you have no access to equipment like suction machines or humidifiers?
How do you support the patient who is wanting to discharge themself as they and their family cannot afford to continue buying food and need to return to their subsistence farming, even though it means that he may never be able to walk again?
What do you tell the doctor about how long a stroke patient will need to be in the hospital when the norm has been to send them home as soon as they are medically stable and you are the only one able to provide rehab services in the hospital?
Any solutions welcome 🙂
One step at a time 
Still looking for solutions to these questions? To be honest I’m sure that I can’t tell you anything that you don’t already know as it’s been just as long since I worked in some of those areas.
For the unconsious respiratory patient…..guessing that it’s hot in Uganda….can you at least leave a bowl of water next to him to evaporate so that the air around him is slightly wetter? Also tracheal rub to stimulate a cough along with positioning? Hard though with nurses to repositon! I remember in Zim, the nurses weren’t used to repositioning the patients regularly, so would react very reluctantly when I came along and asked to turn the patient regularly. Hard! Don’t know if you have this problem there?
Spinal patient…what level is the injury?
By: Cath on 28 June, 2009
at 10:09 am
As you friend cathy said not sure I can suggest much you don’t already know! Also not sure I’m the best person to suggest things with my massive experience in physio lol!! But some ideas:
How do you work with a burns patient who has developed multiple contractures due to not having any physio for a couple of months post injury?
* Create splints out of metal cans/cardboard string etc
* Use pillow & bedding & positioning to create prolonged stretch?
* If the plastic bags braided together are stretchy/strong enough maybe create weight and pully over can and weigh bottle with sand?
How do you treat the spinal cord injury patient who has not had his neck stabilize as is still on the surgical waiting list (1 month post injury)?
*Only thoughts are assess neurological deficit treat what you see & stabilizes neck? Might be a stable fracture?
For sputum retention chap – maybe boiling water in a bowl with towel over head to create humidified air? you have O2 & O2 tubing? put O2 tubing into under towel with humidified water?
Am thinking there must be a way to create a humidifier from bits & bobs lying around, will explain the concept to phil and see if his lateral brain will work 🙂
By: Tany on 10 July, 2009
at 5:22 pm