The calm after the storm

And so physiotherapy returns to normal and it is my last week in the department. I wonder whether I should have stayed so long in one department but was keen to see some of the patients from the previous week followed up, some goals and plans written, organise the store cupboard and try to encourage some note writing. Not sure about the rest but there is now an inventory of all the archaic items in stock, which will either sit there forever or will be used and recycled until they disintegrate or melt.

In sympathy with their lack of resources I attempted a rescue mission on a tatty old splint but unfortunately (or otherwise) the prognosis was poor and it met a wet and sticky end. I wish I could have said the same for the 50 or so boxes of cement mix, bunch of hair accessories, 2 years worth of old newspapers and other interesting artefacts whose purpose can only be guessed at. I discovered plaster shoes that must have been made for a yeti, several moon boots (which bring back painful personal memories), and decrepit old wheelchairs with various essential components missing. I write it all down so that I do not remain the only one with a thorough knowledge of the hospital's stonework and current hair fashions.


I also visit my first inpatient this week. She is my age and seems to have suffered a stroke a few days after giving birth to her third child. She has been lying on a mattress on the floor in the ward for nearly three weeks. We get her up onto a bed (don't ask how), carry out an assessment and find her a chair to sit in - it does the job if you jam it against the wall and ignore the footplates - they would adjust if we had tools, but we don't.


I also take my opportunity this week to suggest firmly to Manuel that it might be a good idea to write some notes every once in a while - especially for the occasions when he burns his patients with the hot pack or causes them to fall, bashing their head on the parallel bars on the way down! Manuel's explanation that 'I am not such a good writer' despite his claim to agree entirely with me, perhaps explains why treatments don't change much regardless of the patient's needs, or why he is never so sure about whether a patient has actually improved or not.


Manuel is Cuban and about three quarters of the way through a 2 year contract here. He apparently qualified and worked as a physician before going on to study physiotherapy, and came to Ghana in the hope of working as both. He has remained in heated debate with the hospital director, who won't let him, ever since he arrived. I must say, I am relieved. However Manuel was most welcoming towards me and allowed me to treat his patients whenever I wanted to, even when I disagreed with his approach to them and his treatments (and changed them) which was most of the time!

The department is led by a Ghanaian lady called Nancy, originally a nurse who retrained in physio about 4 years ago. Her family live in Accra and she hopes to set up her own practice there in the future. Nancy was also happy to work with me, allow me to watch (or lead) and ask my advice about things at times.

I could say much the same about Cinderella, the other Ghanaian physio in the department. She is a few years younger than me, from Ho and has been at the hospital for just over a year. She is happy to just let me join in and teach me about what she is doing and learn anything useful I may have to share with her. I visit Cindy at home sometimes - for dinner, to play scrabble or sing songs (I have made it my mission to teach her a new repertoire of songs from the Bellevue supplement for the kids at her church).


I have really enjoyed working with Nancy and Cindy. I am not always convinced about their assessment of patients or their choice of treatment or documentation (which doesn't happen all that regularly, if at all in some cases), but over the last 4 weeks I have developed a lot of respect for them both - for the work they do within the difficult climate of Hohoe hospital, and their attitude towards their work. I sincerely hope I stay in touch with them.