Sutha

Sutha
Sutha being serial casted

Monday, August 22, 2011

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

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