Indelible Roots

This morning started off pretty slowly. I got out of bed at 6:45am and was on the road flagging down a moto taxi from their usual spot a hundred yards away by 7:15. It wasn’t anywhere near as cold as it was yesterday, but I’m looking at hot, running water with renewed interest.

Work started off slowly. I had my two total hip replacement gals on non weight bearing status. I got them out of bed and walking with forearm crutches out into the sunshine. I wanted to take them all the way to the kitchen about two hundred yards away and had set up the chairs under a large tree on the way. The gal working the motor scooter parking lot called out to me and motioned to something in the tree. On the top of one of the top branches was a large bee or hornet nest and I mean large. So we stopped and turned around to their relief.

The rest of the morning was uneventful with no other patients to see. I spent the time wandering between the therapy room, the consultation room, and peering at the patients outside looking for some extremity abnormality. I then called my twenty-three year old burn patient from yesterday, By Sopha Vann, to see when she was coming and she said noon. That’ll cut my lunch short, but I hadn’t done very much work yet, so I told her that was fine.

At 11am a mother and child shows up with a case of bananas and a couple of large bottles for Samath. I told her he wasn’t in and wouldn’t return until next week and asked her for what she was here for. Instead of an elbow fracture or other physical rehabilitation diagnosis she notes that her son had had palate and lip surgery and was here for speech therapy. So why she brought all this stuff for the physiotherapist I’m not exactly sure.

Well, the translator for speech therapy is out of town with everyone else who can translate English, so I was asked to do it by Claire, one of the three speech therapists from the UK. It’ll kill my lunch hour and I know that it will be pretty complicated from what I’ve observed with their sessions in the past, but either I do it or the patient doesn’t get seen. So I spend the next half hour stumbling along with the mom noticeably not understanding half of what I said.

At noon By Sopha Vann shows up with her sister Paidai with a bag of oranges. I take a measurement and she has -30 degrees of active elbow extension about what we ended up with after an hour of treatment yesterday, so I’m pretty happy. Another few minutes of passive ranging and she’s down to -20 degrees, so we concentrate on flexion. This is limited by the thick scarring at the elbow crease, but we get to full range after a few minutes. I then massage the heck out of the scar, pinching and pulling. Then I have her do some active elbow flexion and extension and get her up to two kilograms with some difficulty; very weak compared to the unaffected side.

All along we’re having a good old time talking. They don’t believe that I’m here without pay. They also ask to buy my only scar massage vibrator which is absolutely not for sale. Then they ask why I only brought one and I told them I brought two suitcases full of supplies. Then they find out I’m looking for a new place they ask if they can look for places for me. At the end of the session I tell Sopha Vann I want her to go to PT House to get evaluated for and fitted for a compression stocking to work on the scar.

At this time my first hand patient at CSC shows up with her mom and sister with a whole uncooked chicken, two coconuts, and a bag of num buk. I look at her finger and to my dismay see that the index finger is contracted at the PIP about 45 degrees and the middle finger is scarred down completely. I’m pretty pissed off now as I thought she was discharged home too soon. Mostly I was mad I didn’t make her night splints as Samath had suggested. I can get her index finger to full extension passively and start to make a splint for it. But the middle finger will have to be surgically released and skin grafted yet again.

By this time it’s 1:40 and I want to go to the monthly acid burn conference at PT House. I grab Stephanie, the new medical student from Australia and we pile into Lyna’s car for the fifteen minute trip. Lyna drops us off and heads on to some English language test she’s been doing for the past two days to get placed into an English language school in the evenings. Sopha Vann and Paidai follow us and she meets Jun Tary, the PT House physiotherapist who looks at her arm and tells her to come in the morning so that she can take measurements for the compression stocking.

The conference was much less medical than I had imagined it to be with such a title. It is actually a monthly support group meeting for victims of acid burns with some medical staff present. Dr. Jim talks about a young woman who committed suicide recently and stressed how it was important to let them know if there was a victim who was isolating them self. They also brought up a job offer to work at an orphanage in Kapoung Somn and the possibility of expanding PT House to a second location in a different city.

Another program they are instituting is offering monthly $10 payments to victims or children of victims who were enrolled in school. They also showed off some nicely knit bags the patients had made and were for sale. I was more interested in the container of fishing flies. Picking it up I found some very nicely tied egg sucking leeches. I asked Bolle who tied them and was told the nice ones were done by some completely blind patients. I was surprised as I cut myself all the time just tying them onto my leader on the river.

By this time I’m starving and pull out my bag of newly acquired oranges and chow down with some relief. Towards the end of the meeting Kanya (Dr. Jim’s wife and CEO of PT House) asks if anyone wants to say anything. I speak up and ask if anyone has an upper extremity issue. Kanya then has me look at a nine year old with acid burns to most of her head, part of her face, all of her neck, and one side of her torso. She tells me that this girl came to them four years ago completely contracted over to one side. She now moves well in almost all areas, but her neck is starting to contract on both sides. I tell her I have very limited experience in this, but that from a previous burn conference young children will have to go through multiple surgeries as they grow up and the scar doesn’t stretch with them.

Kanya then goes on to tell me the sad tale of how this happened. She wasn’t attacked by an angry parent or neighbor. Her mom poured a water bottle over her head thinking it was water when it actually contained acid. Acid is used in the production of rubber somehow and is common in households in the province they are from. Immediately the news story of two Alaskans who drank a Coke bottle full of anti-freeze and died this past summer came to mind.

I then meet a young man with terrible acid burns to his entire face and head and one arm. He only has about 45 degrees of range of motion in the left elbow and it’s not limited by scarring. Dr. Bonvath, the CSC Chief of Surgery and the only plastic surgeon aboard tells me that they immobilized the elbow when they grafted the arm and in the one to two weeks the graft took to set they lost all of that range of motion. I discuss it with Tary and we decide to have him come to CSC daily for a week. I’m not very optimistic, but I’ll make him a homemade static progressive flexion splint and a static extension splint.

Dr. Jim had left after thirty minutes of the meeting and calls me back to CSC to see a patient. I flag down a moto taxi and get on for the slowest ride in my life. The clutch was going on the beat up scooter and I had a mind to jump off and catch another one, but didn’t. The fifteen minute ride took twenty-five and we didn’t do more than five miles an hour going uphill.

Back at CSC I find the Krukenburge patient who had his radius and ulna separated when they amputated his cancerous hand. Dr. Jim was happy with his progress and wanted a new home program for him. I had talked to him earlier in the day and wasn’t impressed as he wasn’t actively using that arm at all, except to do some range of motion. So I got him picking up 1.5kg dumbbells wrapped in a cloth a few times and urge him to do similar things at home if he is going to be able to use it for anything useful in the future. I’ll see him again in the morning before letting him go home.

I try to offer my naked and uncooked chicken that has been sitting in the un-air-conditioned therapy room all day, but no one would take it, saying it was for me. So I hitch a ride with the nurse Sophal who has a great if gummy smile and she drops me off at uncle Chheang’s. Here he and I have a good time talking and his daughter Meang stir fries the chicken for dinner. Uncle Chheang goes on to tell me that he doesn’t want me to move into the other cousin’s house in case things don’t work out and we end up with animosity towards each other. He wants me to move in with him, saying that he won’t say anything no matter what time I come in at night or whatever. I find the conversation very funny. All the previous hard feelings from the previous week disappear and I leave happy and content.

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This entry was posted on Friday, November 30th, 2007 at 1:56 pm and is filed under Khmer. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.