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

The bed carriers

One of the VIC clinics is in Prey Veng. Prey Veng is rural. The clinic is down a muddy dirt track. The patients come from far and wide so they stay at the clinic in dormitories and come to the centre during the day for their treatment sessions.

I could not believe my eyes when I saw four men carry a wooden bed with a woman on it out of the physio room and then put it down outside at the end of the day. I am not sure what the woman’s condition is but she does not get up from this bed… ever.

Little orange pills

Yesterday we checked one of our patients’ blood pressures. It was extremely high, giving a reading of 205/160 (normal 120/80). The next day the physio pulled a packet of orange pills from his pocket and gave them to the man, who popped a few straight away. “For blood pressure”, we were informed. What was even more surprising was a few hours later, one of the wives of a patient staying at VIC (Prey Veng) asked to use the manometer to check her blood pressure, and decided it was high. So the first patient gave her some of his orange pills! I stood back in awe. 

Frustration

Some days can be extremely frustrating. It is such a horrible feeling when you walk in to a room full of foreign people- one of them says something in Khmer and the rest start laughing. This probably would not affect me so much usually, only I was tired, hot and frustrated. Things were getting to me a bit today. 

And how could he not understand what I wanted him to do? It seemed simple enough- all I wanted was for him to stand there and shut his eyes so I could see the impact removing vision had on his balance! Really not that difficult!

And the other guy who I’m pretty sure has some cognitive issues but I to what extent- I have no idea. He will not do anything I ask/ show him. It’s like he’s completely disinterested.

Then there was the baby, or rather the three -year old, who would not sit still. This would be ok but the mother kept taking him from us and making him do bridging exercises or stretching. There is no proven evidence behind stretching for CP dammit! 

Cycling

We cycle to the clinic each day, Megan and I with our backpacks and sunglasses. We have rickety old gearless bikes, but for $1/ day, who can complain? And we have baskets at the front... Anyway, the way there is pretty sweet, it's 7.15 am so the heat is yet to reach it's full potential. This, however, does not mean we aren't sweating profusely when we arrive at a quarter to 8 to begin work. Riding up and over the bridge without gears is heavy duty and the bright morning sun is a killer.

It's Tuesday afternoon and we’re riding our bikes home from the clinic. It’s peak hour so there are even more cars, mopeds, bicycles, cyclos and people on the road. It has been 35 degrees + all day and half an hour before we left it thunderstormed. So we are riding our rickety gearless bikes without a helmet in bright yellow ponchos and going about 5 km/hour. Not for the first time, I think to myself, “Only in Cambodia”. We ride in the hope that everyone else avoids us… and they do somehow. There are near misses of course, and sometimes not near misses, but usually it somehow just works. The roundabout is chaos. To get to our street, we have to cross to the centre of the roundabout, then to the edge to exit it and then a few lefts and a few rights. During this time the only thoughts through my mind are, “I’m still alive, I’m still alive, I’m still alive!” The poncho by now is sticking to my skin as rain does not mean a drop in the temperature and by no means does it mean a reduction in the humidity! As my legs turn circles, I find my thighs sticking to my calves! When we get back to the hotel we are not wet from rain, as that ceased a while back, we are drenched in sweat. And now we have to climb three flights of stairs...

Torticollis Monday

At the clinic, each day has a specific condition assigned to it- Monday is torticollis day. Torticollis is a congenital condition whereby one of the muscles in the neck becomes twisted, usually due to the baby's position in the womb. Monday mornings see dozens of mothers nursing their young on the plinths in the physio gym waiting for a clinician to attend to them. In that sense, today was no different. However, today was quite amazing. Last Monday we not only learnt what torticollis was and how to treat it, but we taught many mothers how to manage it too. Last Monday (and most of last week) I made many babies cry- I don't even know why- but it was upsetting and I felt helpless. Today I stopped a baby from crying and then he fell asleep whilst I was rocking him! And the next baby didn't even start crying and then she fell asleep too! I felt invincibly maternal! Bring on torticollis, baby!

MILF

A child walked in to the clinic today wearing a T-Shirt that read I Love MILF... I thought, 'Only in Cambodia'

Savon's story

Savon is a 72 year-old father of two who sustained a traumatic brain injury and crush fractures in his lumbar spine 4.5 months ago. He was sent home from hospital after a craniotomy with a lumbar brace and spent the next 4 months or so in bed, his wife and son having to carry him up and down their 6 stairs as he couldn't walk. He heard about the Prey Veng centre and is starting a rehab stay here - he stood for the first time since his accident yesterday and is doing a great job. We taught his wife how to transfer him safely to and from a wheelchair and hope to get him standing on his own within a few weeks. In physio we are working on strengthening, postural control and a lot of education about rehab and remaining active. (written by K. Kaminsky)

Tili's broken arm

Tili broke two bones in her forearm in December 2010. She visited a Khmer healer, who's treatment consisted of a bamboo splint and local bush leave ointments for one month. Tili's arm was not getting better so she went off to the hospital for xrays and subsequent surgery consisting of a plate and screws. These, along with the plaster cast, were removed after six months and this is when Tili first visited the centre. One of the physiotherapists assessed the movement in Tili's arm and saw the broken bone fragments moving under her skin. Another xray was taken and no healing had taken place- the bones were still separated. Now Tili is in a half splint to prevent wrist movements. It cannot be a full splint as there is also an infected wound on her forearm. Physiotherapy is working on her finger and upper arm movements as her wrist is to be kept immobilised.

Mika's story

(names are anonymous)

Mika was a cleaner but was not making enough money to support her son so she decided to look for other jobs. Not long after she was offered a job working with a farmer on a rice farm. She was riding on the back of a truck one day when she fell off. She broke her cervical vertebrae in two places and was paralysed. Mika had no money to go to the hospital so she was taken home and lain on wooden slats in their hut for ten weeks. Her son quit school and his job to care for her. CHOICE (Charitable Humanitarian Organisation in Cambodia by Expats) were notified about Mika and brought her to a hospital where she was able to get surgery. Mika has incomplete tetraplegia. Initially unable to move her limbs, Mika now is working on sitting and standing with some support. She comes to the rehab centre daily for physiotherapy and is progressing well. Her son is there with her assisting every morning and afternoon.

Introduction

Welcome to our blog! We are 4 physiotherapy students from LaTrobe University Melbourne undertaking a placement at a few rehabilitation centres in Cambodia. We would like to share some of the patients' stories and our experiences as the trip unfurls...