Thursday, November 16, 2017

Girls will be girls...

Sometimes I get tired of doing the same thing in the physical therapy clinic. But 75% of my patients have the same diagnosis (stress urinary incontinence), and the remaining 25% have one or more of a handful of diagnoses (urge urinary incontinence, fecal incontinence or seepage, urinary retention, urethral leaking, obstetric-caused foot drop, and leg weakness). I will usually get 1-5 visits with each woman, so it feels like I'm constantly starting over.

But this week was different...

One of my current patients, let's call her Fatima, is just a teenager. Following a stillbirth a few months, she developed significant foot drop as well as urinary incontinence. We are grateful that she doesn't have a fistula that requires surgical intervention, but her pelvic muscles are too weak to provide any assistance to the bladder and the urethral sphincter. The prolonged pressure on the nerves in her pelvis during the prolonged labor are the nerves that control the muscles in her legs, especially the muscle on the front of the shin that pulls the toes up. Now she must hike up her hip and really bend her knee to move that leg forward as she walks or else she'll drag her toes and trip.

I have limited diagnostic tools and treatment options. And even if more sophisticated treatments like biofeedback, internal electrical stimulation, AFOs (ankle-foot-orthoses), and neuromuscular re-education were available, I'd spend so long explaining it to the patient in order to 1) allow us to try it and not be afraid of it or 2) understand what she's supposed to do in coordination with the machine. So I use my own hands, a limited supply of Theraband, a pillow, a set of stairs, a plastic chair, and a exercise ball... and D__, a very patient nurse aide who interprets for me and is learning how to be a PT tech.

But some days you just gotta get out of the small PT room (12' x 15') and get moving! And if you're in Nigeria, you can't move without music! There's an open area just outside the door to the clinic that's usually full of plastic chairs where women wait to be seen in our Tuesday medical clinic. I decided to move our session out there so we could have more room.
The fabric panels on the right hide the floor-to-ceiling wooden shelves that are full of unsorted patient files from the early years of the VVF Center. Can you say dusty!!! I use the whiteboard to draw out exercises for patients as well as when I'm teaching D__. The treatment table was custom-built this past summer with a donation from the PT Assistant class at Northeast Texas Community College where I used to guest lecture. It's the perfect height for me... but my patients have to use the steps to get up there!

The PT clinic is down the hallway where that glass door is.

For the last week we've been working on weight shifting, single leg balance, normalizing the length of her steps as she walked, and entire leg strength on the affected side. Yesterday, we decided to incorporate all of those activities into a sort of therapeutic dance. D__ and I would slowly do each step and Fatima would mirror us as best as she could. After struggling with balance, I held out my hands so she could use me for balance. She was shy, but then both hands appeared from the folds of her hijab and she placed her palms in my hands and we began to dance.

I thumbed through my phone to an album of Nigerian worship music and hit play. As the music drifted down the hall to the rest of Evangel VVF Center, some of our youngest patients come to say hello. These three little girls are either awaiting surgery or recovering from surgeries to correct urinary problems they've had since birth. Usually, this is the result of a duplicated ureter that implanted into the vagina into the bladder so the urine produced by the kidney just flows out without any control. Other times, female genital cutting can damage the urethra and bladder, and still others have abnormal urinary systems due to birth defects like spina bifida and epispadius. 

One of our more adventurous young patients (the girl on the right in the red and black dress) marched right in and sat down on one of the wooden benches lining the hallway, the other two peeked around the corner until I invited them to join in the dancing with "ku zo" (you (plural) come). We all held hands, formed a circle, and mostly just swayed and step-tapped side to side. Occasionally D__ or I would call out "ki juya" (turn) or "yanzu, ki sa ƙafarki a baya" (now, put your foot behind) to mix things up a bit. I'm not sure Fatima understood my Hausa, but at least she could follow my demonstration.

As I stepped back to allow D__ a chance to work with Fatima, I was excited to see her putting weight evenly on both legs, better awareness of her problematic foot so she could do a grapevine step, and how hard she was trying to get up on her tippy-toes. But my heart was thrilled to see the smile on her face as she danced and had an opportunity to just be a teenager again. 

Girls all over the world love to dance. What a blessing it is to help Fatima get moving again. But please pray that each of these sweet girls will meet the Savior so that one day we'll hold hands and dance together again in heaven!
D__ in the middle and Fatima on the far right

I didn't catch any photos of us dancing, but I happened to catch this adorable picture of one girl "backing her baby." She even leaned over at the waist, placed the water bottle on her back, and reached around with the scarf to tie the "baby" on her back. When it slipped out, one of the other girls helped her tie Baby more securely. I'm reminded that young girls will mimic what they see their mothers doing. In the US, I've seen girls swaddle a pinecone in their jacket, pretend to feed it, and even "shush" me because I'm being too loud and "baby is sleeping." Here in Nigeria, a water bottle and a borrowed scarf help this young girl practice her Mommy-skills. Too precious!

No comments:

Post a Comment