Friday, February 16, 2018

Life as a Missionary PT Part 5: PT Introduction and Subjective History

This is part 5 of a series of posts about what my ministry is like.

Remember, I'm just sharing my personal experience with this particular hospital in this particular country. Other missionaries at this same center will have different viewpoints, as will missionary PTs serving in other places.

Most of my patients have never heard of physiotherapy, and even fewer have any idea what a physio does or the types of conditions they treat. So it's not surprising when the fistula surgeon tells them that instead of having surgery they're going to work with physio.

In the US, when I meet a patient for the first time I say something like, "Hi, I'm Kate (or Dr. Kate) and I'll be your physical therapist. You'll also get to work with ___, my PT Assistant. I see that Dr. ___ sent you to us to work on ___." Then I'll usually ask them what their main issue is and what finally brought them into PT. Sometimes I get the run-on story that seems to have no point and no connection whatsoever to their physical impairment, but I've learned to listen well and try to guide their storytelling so that it answers my questions.

Here, it's very different. First off, names and titles don't play as much of a role in this clinic; she just wants to know I can help her. Also, I have another woman with me to translate. That means that when a patient enters the PT room, there are two sets of greetings and answers back! Sometimes a woman will come with her small child (those are the fortunate ones to have had a live child, despite sustaining a fistula), so I'll ask after the baby. Just this morning when I went to call my patients who were sitting on the front steps of the fistula center, I interrupted a mama giving a bucket bath to her toddler girl. Instead of finishing the girl's bath, she just handed the water dipper off to another woman and followed me to the clinic!

So, we get settled in the clinic. Me sitting on a step stool, the translator in my desk chair, and the patient on a plastic chair that we can wipe down if she has an accident. 

I take a quick look at her brown patient card, taking note of the number of surgeries she's had, the types of repairs we've done, when the last surgery was, if we've prescribed specific medications for overactive bladder before, and the number of children she's had.

Then I tell her something like, "The doctors didn't find any hole that is making the urine to come out. But we think that the muscles in your vagina are weak or aren't working correctly. There's no surgery for this, and you don't need any medicine. I will teach you exercises to help your vagina." That always elicits a strange look from them!

I don't usually ask much about her history other than what is on the card. Here, people either don't have a health history, or don't know how to describe it. And I don't do a medication review except occasionally asking "That medicine we gave you before--the one you take at night--does that one help you?" Sometimes I really don't want to know what traditional healing concoctions she's tried!

So I ask about their symptoms right now. Again, these questions are worded differently than if I was asking someone in the States. And I find myself talking in broken English to my translator because it aids in literal translation to Hausa and occasionally the patient will understand my English question. 

"When you cough, the urine it do come?"
"When you feel pressed, can you go to that place (toilet) before the urine drops?"
"Does the urine drop small small or much?"
"When you wake up in the morning, is your bed wet?"
"If the urine starts to pour, can you stop it?"
"Do you have to put rag?" (incontinence products are not available here, aside from a few places that carry adult diapers, so most women place rags inside their underwear to absorb leakage)

I find that sometime she'll have a hard time answering these questions. Maybe it's a difference in the Hausa that we speak, maybe it's the fact that she don't know when she's wet, they just know that she's wet, maybe it's the fact that she's embarrassed. I also find that a woman's age, her religion, and education status play a role in how well she understands my questions and accurate her answers are. 

That all takes about five minutes. A far cry from the 15-20 I might spend in the US. But I get the information I need, or all the information I'm likely to get from her anyhow.

In the States, after I get the history, I always ask my patients what their goals are. Sometimes the goals are pretty obvious (reduce pain, walk without an assistive device, get back to sports), but sometimes they're more unusual (be able to hold urine for 2 hours so she can go on a retirees-only bus tour, be able to pick up a bag of deer feed without pain). I don't really have to ask about goals here--they all want to be dry. If they can tolerate sex again, or be dry at night, that's a bonus!

I'm learning how to do PT treatments with little information; just enough so I'm not shooting in the dark, but not near what I'm used to getting in the US. But that's OK. I can always ask more questions later, and I'm learning to be better in my examination skills so I can find the answers out myself. And that is what the next post will be about...

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