Ly's horrific surgery

In Krati Megan treats a girl who had an immunisation. The needle entered her muscle instead of being subcutaneous causing a contracture of her quadricep muscle (the muscle spasmed and tightened in response to the injection). So the surgeon for some reason decided it would be a good idea to take some of the skin from Ly's knee and calf and attach it to her thigh. Ly is seven years old. She cannot walk as her muscles are very weak and she has gruesome scars on her legs. Megan tries to strengthen and stretch Ly's muscles and massage the scar. They do this twice a day. But Ly will need a lot more treatment than she will be get. It is unlikely that she will fully recover, she needs surgery to remove the scar tissue because it is severely impacting her function. Megan has requested the clinic send her updates on Ly's progress.  

OMG what did I just see on that moto??

For anyone who has been to south each asia you would know how many motor bikes are around. You would also know that there are some crazy things that the people load up onto their motorbike. We have seen cages of chickens and pigs, entire families including mum dad baby grandma uncle. Palm trees roots and all, stacks of hay bails, hundreds of kg of rice. But last night as we were riding home, we spotted possibly the most outrageous motorbike of all, the father was driving with a helmet on, the mother was on the back without a helmet, but she was holding up a tree branch with a saline drip bag hanging from it, leading down to her baby, which was in her other arm... hmmmm 

Sutha

Sutha is the first person we have seen that has used the thermoplastic that some of you helped contribute to from the fundraiser. THANKS. Sutha is a 15 year old boy who fell out of a tree and was paralysed from the waist down. After a few weeks he had spinal surgery, which left him in a wheelchair. He cannot walk because each time he takes a step his muscles don’t work to lift his legs off the ground (bilateral foot drop). Between the orthotist’ and the physio’s we made Sutha two ankle foot orthotics to help Sutha lift his legs to clear the ground. He can now walk with 2 crutches and no longer has to rely on the wheelchair. He will be returning to school in the next few months when he can walk to school without the crutches and he should be able to attend his normal class.

Thanks guys!! What a fantastic outcome for this young boy!! We hope the rest of the thermoplastic is used to help more Cambodians who are in need! 

By Megan Hingston

And then we got sick...

Maybe it's the long days at clinic, or the fact that we were 50m from the TB ward in Kratie, or it could have been the big weekend in Siem Reap... but we have all ended up quite ill for our last week of clinic. Megan has had the shits for 3 weeks and has only just visited a hospital- where she ended up on the drip! Katie, who is diabetic, has had swinging blood sugar levels + vomiting for about 24 hours, Jas has a shooting temperature and cold and flu symptoms leaving her bedridden and I am absolutely congested from head to tail! With Jas and Katie leaving early for bed and Megs visiting the hospital, I had to hold the fort this afternoon and for the first time in Cambodia, I felt very busy and a tad stressed... it was actually quite comforting! But hey that's a Melbourne girl for ya

Kratie

Kratie is home to the third VI clinic. It is a beautiful town, recently subjected to a market fire and later, flooding. Nevertheless the sunset over the river and the friendly atmosphere charms us. We immediately find a kind hotel manager, a favourite market lady and a great bar owner- each of whom we revisit on several occasions during our short stay in Kratie. This is the town. A fifteen-minute walk (or five minutes by Cambodian description) is VIC in company of a hospital. A lovely site manager who is extremely welcoming runs the centre. If I thought things were layed back at the other centres, this place is in extended slow motion. We spend all afternoon with a patient each, which is great for them as the majority are neurological patients, of whom will benefit greatly with prolonged one on one treatment time.

The centre comprises of one physiotherapist, one P&O, two technicians, the site manager, an administrator, a teacher for the school for the children of the families staying there and the site manager. The patients are scouted from the community once a month and brought to the clinic for treatment.

Hik is a twenty three year old male who’s story got a bit lost in translation at first. However, in the end we managed to gather that he fell over whilst running and probably broke one of his lumbar vertebrae. He went to hospital as he could not feel or move his lower limbs. He stayed in hospital for fifteen days, being treated with “medication”, but there was no progress so he was sent home. In Cambodia, many doctors do not know about physiotherapy. When Hik came to us, no one had explained his condition or prognosis do him. He did not know what was going on. We tried to educate Hik about pressure area care and prevention of contracture and about goals he can work towards as a wheelchair bound individual. All of this was too much for Hik to take in and he appeared to become quite distressed. It had been five months since the accident but all the information was coming at once after so long and it was overwhelming so encouraged him to rest and we would see him again tomorrow.

Hik is now working on sitting balance, strengthening his arms to propel his wheelchair, independent management and care, including transfers and improving continence. 

AND THEY ALL FALL OUT OF TREES.

Yes. It's true. Every aquired brain injury patient in Cambodia fell out of a tree. Well, almost. One fell out of a tr....uck.

Na Leak's story

Na Leak is a bright and bubbly 26 year old. Her diagnosis took a few days to work out. Jas and I initially understood that she sustained a traumatic spinal cord injury in March from a motorbike accident. Turns out she actually has transverse myelitis (we're still not certain of that though!), a disease that destroys the nerves at one level of the spinal cord. We think she had the disease before the accident and suffered a severe exacerbation of her symptoms after the accident. She has the worst spasticity in her legs that I have seen in my limited experience, and is wheelchair-bound at the Kien Kleang centre. She doesn't own a wheelchair so stays on her bed at home - we dressed two pressure sores on her ankles the other day - and has no control over her legs, suffers from some incontinence, burning pain and reduced sensation. Despite this she is a really enthusiastic participant in physio - we have been getting her up on the tilt table every day, which she absolutely loves, and have been working on transfers from the wheelchair to the bed. This is somewhat difficult as her legs either spasm into flexion or full extension every time she tries to move, and she gets shooting pain from her hips to her toes. Another complication is the fact that wheelchairs with removable arms don't really exist in Cambodia so we can't teach her the conventional slide-board transfer. Despite this we are making amazing progress - she says that the spasm is far better now she is weight-bearing daily on the tilt table, which in turn reduces her pain. Spasticity management in Cambodia is complex: a 10-day supply of oral Baclofen costs $15 which is hugely restrictive considering the average monthly wage is around $40 USD. Botox is available but similarly is hugely expensive and hard to access unless you live in Phnom Penh. Rhizotomy is not an option as no surgeon performs this operation in the country. Na Leak's case has really highlighted both the importance of communication (it took a week of translations, interviews and phone calls to work out that she had no spinal fracture and had received treatment before) and how limited therapy can be without access to the latest treatments. Despite this we have seen a huge improvement in her independence over the past week, which puts a bit of a positive spin on the situation! - written by Katie K