Myself and 4 other classmates were assigned to work in the physiotherapy department at Black Lion hospital here in Addis Ababa. Black Lion is the largest hospital in the country (720 beds!) and the physiotherapy department alone staffs 23 PT's. The PT's rotate on a 2 month schedule between casting/plaster, electrotherapeutic modalities, inpatient care ("the ward"), pediatrics, and an outpatient clinic. The hospital is by far the most crowded facility I've ever been to. People are literally everywhere- hospital beds haphazardly angled throughout the hallways and terraces, no private rooms (there may be ten patients in one room!) family members surrounding and medical staff literally running between people. Power outages are common here and so most of the time everything is pretty dark. I went to order some plaster materials from the pharmacy today and it was push-and-shove just to get to the counter to order my supplies.
The PT's here receive their bachelor's equivalent with 3 years of PT school. There is a clear resistance between the physio staff and the doctors here- most doctors do not support PT nor know what we are really capable of - it is much more pronounced than in the US. However, with the high incidence of diseases like HIV/AIDS, Tuberculosis and Malaria, it's also understandable that much of the focus has to be on saving lives rather than improving the quality of life. Disability is so high here and it's unfortunate that PT here does not have more support.
So far I've been working in the outpatient clinic entirely. Today was Day #3 in the clinic. The main challenges thus far have been the language barrier with both the patients and local PT's- but this is getting better. (My Amharic is improving and I am used to getting laughed at as a "ferenji" - foreigner!) It's also difficult to know where our boundaries are as visiting students. We don't want to "step on toes" so to speak- and our school background appears to be more thorough than what the PT's here were exposed to. We do not want to "correct" anybody but at the same time it is hard to stand back and watch techniques when we believe that there may be a more evidence-based option. There is a brand new electrotherapautic modalities room and the Ethiopians are very proud of it. However, from my schooling I believe in a more hands-on approach and there is not a lot of evidence behind the ultrasound, diathermy and infra-red machines used here as opposed to more recent PT techniques.
On the contrary, there is also a lot that we are learning from the PT's here and our cultural knowledge and experiences have been very interesting. The patients are very friendly and welcoming. I have become quite attached to many of them! We are now used to the prison guards with shotguns that pace around the clinic when we are treating prisoners!
The patient case load is different from the US, even in the outpatient side of things. With poor road conditions, pedestrians everywhere, and lack of seat belts in cars, combined with poor nutrition, many orthopedic injuries revolve around bone fractures. Most of my patients suffer from what they term "fall-down injury"- many broken tibias and femurs that were displaced fractures that did not have surgical options secondary to lack of resources. So many of the patients are 3 and 4 months post-fracture with huge leg length discrepancies and edema/weight bearing problems. We also see a number of patients with low back pain, hand injuries, and neurological injuries.
I have a very interesting neurological case I will share later. Until then- Letinachen! (Cheers)
Thursday, March 25, 2010
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