Hotel Bound...

Today was a great day.  A little chaotic for my liking but it was very productive.  I arrived at the clinic and I had two hours to co-treat with the therapists before my presentation.  I had a patient that was 8 months post-op menisectomy and was only receiving modalities.  She had developed patellofemoral pain (pain in the front of her knee) so she had been using a wheelchair and had not been walking.  I demonstrated an evaluation, prescribed a home program and relieved the pain with McConnell taping and a Mulligan mobilization.  She was so excited to learn that she could do the technique at home that she didn't stop doing the mobilization all morning! She walked out of the clinic! They told me it was 'magical.'  I had therapists all morning saying they had patients they wanted me to see and said they were bringing them to the presentation so they could learn!!! So, I arrived in the room where I was supposed to give my presentation and the room was so full with patients and healthcare providers I could barely move.  I was a little unsure as to what I was supposed to be doing but decided to get creative and have all of the patients serve as examples of different Mulligan techniques.  As it turns out, I had to evaluate each and every one of them before using the techniques or giving them exercises since the therapists in Peru do not do evaluations (they do not document anything).  The scripts say 'pain'.  So it was a rather arduous task (since everything I did had to be translated and I had to make sure my translator understood!) but the therapists learned so much that it was well worth it.  I am having two of the therapists, Douglass (pictured below, practicing a knee eval) and Jolio follow me closely and demonstrate so that they can be the liasons when I am gone to help the other PTs. They are excellent clinicians and very eager to learn.  An interesting case this afternoon; a patient that suffered a calcaneal fracture 7 months ago.  He walked in non-weightbearing with two crutches.  He was unable to move his foot.  This was primarily due to being casted for many months, and once out of the cast he did not put any weight on it or move it.  After treatment, he had functional range of motion and was walking.  This was the perfect example because the gains in range of motion are often the greatest after cast removal.  Needless to say I never got to my presentation but the patient examples were far more valuable and covered almost everything I was going to talk about/demonstrate!

I went to lunch at the hospital cafeteria with Maria (my translator, pictured above).  I am still fascinated by the size of the lunches! It was during lunch that I developed 'travelers distress'.  Something that I have taken great caution to prevent but I am plagued with it; hotel bound.  I have had some time to think since I cannot leave.  I have two theories: First, it could have been that I accidentally put my toothbrush in the sink water, then touched my toothbrush to the bottled water as I cleaned it off (then took a drink from the bottled water this morning forgetting that my toothbrush had touched it).  Or, it could have been that I ate a couple of mussels...hmmmm.  At any rate, I will say that if it was the mussels, at least they were good.   I am hoping this will not last into the morning since it is a long commute and I have a long day ahead of me.  One of the PT's is taking me to see the glass churches and 'mirrar montagne' (see the mountain????) tomorrow, should be fun.

A rough start

Today was my first day at Hospital Alberto Sabogal.  This is the smallest of the Essalud hospitals (1,000 beds) and is the farthest from the center of Lima.  The hospital sent a driver to pick me up at 7:30 accompanied by one of the PT's that does not speak English.  The driving was so rough (no seat belts, cars honk to let people know they are coming up behind them, no traffic signals etc) that I got carsick.  The car did not have an exhaust and due to safety I was unable to roll my car window down or stop on the side of the road.   So, I motioned to the PT in the backseat with me that I was going to be sick and she dumped her work clothes out of her plastic bag and gave it to me.  We got to the hospital and she got me some coca tea and that seemed to help.  A rough start to day one!
The therapists at the clinic are great.  I could tell instantly that they are passionate about their jobs and were so eager to learn (they skipped lunch so they could learn more!)  There is only one therapist there, Maria that spoke some English- she was instrumental in helping me to navigate around the facility and communicate with the other Dr.'s and therapists.  I got a brief tour of the facility upon arrival.  There were roughly 60 people in the waiting room for physical therapy.  Maria told me they typically see anywhere from 4-6 patients per hour.  The PT dept was very small and had about 10 treatment stalls in which they would treat 4-5 patients at a time.  The treatment is almost exclusively modalities.  It was in one of these stalls that I came across a woman that tapped me on the shoulder.  She was in her forties and had a tibia fracture 5 months ago.  She spoke some English and asked me very sincerely if I thought she would ever be able to walk again. She said she has been non weight bearing for 5 months so it could heal and that her muscles in her leg were so small she didn't know if they would support her to walk (she had severe atrophy and I could wrap my thumb and index finger around her calf.) Many patients asked me similar questions because Maria said Peruvians highly respect healthcare in the U.S.

This morning I gave my first course on Mulligan mobilization for the upper extremity.  Pictured is Raoule who is a 'self taught manual therapist' practicing a neck technique.  They did not have the appropriate projector adapter for my Mac and while I had it saved to a flash drive, nobody had a PC.  It worked out fine though.  I wanted to do more lab work than lecture so I presented the theory and had the therapists find a patient that would be appropriate for each technique.  I had a room full of people lined up.  I demonstrated in front of the group (a very large group of students from the university, therapists from the hospital and doctors).  One of the patients was being discharged today-he only had 45 degrees of abduction (out to side) 85 degrees of flexion and could not hammer for his job or reach his hair to wash it.  However he finished the amount of ultrasound treatments the physiatrist ordered (physiatrists dictate treatment) so he was discharged.  I did the Mulligan technique for shoulder flexion and they were all very amazed at the range of motion he gained. He just smiled and said 'thank you, I have my arm back' It was nice to have some real life examples.  The hospital bathrooms did not have toilet seats, toilet paper, soap, or paper towels.  I am still having a hard time getting used to this! I have included a photo of a dog that was wandering outside the hospital...interesting??????!!!!!!

New food and new friends!

Today was a very exciting and busy day! I walked through the city this morning and came to a street that had been shut down for the day.  This is where the kids play soccer (photo attached).   A young child kicked a ball and it rolled towards me so I kicked it back.  He smiled and said something but I couldn't make it out.  There was a man standing behind me and he said "he told you you have a very good kick and you should play with them."  I declined but the man proceded to let me know that I could join the Peruvian National running club that meets at 5 a.m...something tells me they would blow me out of the water and I would be left lost on Larco Avenue haha.  This afternoon I met up with Carla and her son Steffan (sp?) for lunch.  Carla is a friend of a friend from Maine.  She took me to a wonderful restaurant Costa Verde. The restaurant overlooks the Pacific Ocean and had every food imaginable.  In Peru, lunch is like dinner.  Often three courses and the biggest meal of the day.  I had everything from mini octopus to my first Pisco Sour (pisco is Peruvian Brandy).  The food is all very good although it will take some getting used to eating that much food in the middle of the day! I have attached a few photos from lunch (appetizer, main dish and dessert whoa!).  We then went to the Miraflores Park for a walk.  Here we saw 'Lovers Statue' (photo attached).  It is a beautiful statue.  Carla dropped me off and Ana, my translator and physical therapist at hospital Almenara  was at the hotel ready for our 6:00 coffee (Peruvian dinner?) meeting.  She brought her secretary/assistant with her.  I gave them the supplies I donated to their clinic and they replied 'this is like gold to us, we will wrap it so nobody can see it and take it.' They currently use bicycle tires for Theraband.  I also gave them some braces that were donated.  They looked them over and tried to come up with ways they could duplicate the locking mechanism. Ana informed me that they currently make straight leg braces out of PVC piping but they don't unlock so they were fascinated by the braces I gave them.  We went out on the town this evening and they showed me where everything is located in town etc.  I start at Sabogal Hospital tomorrow.  They changed my first site last minute due to 'internal issues'.  It will be a 1.5 hr commute each way...slightly longer than my commute in Maine haha.  Oh, and two more things: Yes, I ate the entire meal this afternoon and my borrowed converter from the front desk blew up so I now have no operating outlets in my room...I asked if they could fix them and they gave me the same converter that caught fire!!!!!!!! Off to Sebogal, Peru bright and early!

Room with a Better View and Bicycles!

Bicycles and Markets

Dear Diary (haha),
This morning I was sitting in the hotel using my limited Spanish to order breakfast.  The guy sitting next to me asked if I spoke English...I said yes!! We were talking and he said he was in Peru to fix cleft pallets.  Come to find out he is a surgeon from Nebraska.  He was also only staying one night at the Colonial then moving to a different hotel because of vacancy-he was going to the same hotel as me!  So, we shared a cab and when we got to the second hotel (which is far more pleasant) we decided to tour the city which included the wonderful market and eating some good seafood.  My breakfast included some delicious papaya juice, coco tea, eggs, chicken, cheese, tomato and some fresh papaya.  Lunch was equally as delicious: Squid, scallops, shrimp in some sort of sauce over fried fish.  This came with potatoes that looked just like hollandaise sauce! There are lots of entertaining bikes-plant bikes, oil bikes, pastry bikes, fruit bikes and much more.  I am amazed at how friendly and polite everyone is here.  People always open doors, carry luggage etc.  One thing I do find interesting is that you cannot put toilet paper in the 'water closets.' This is a bit garbled but going on very little sleep so you will have to bear with me! Tomorrow, I meet with my translator, Ana to go through my courses and figure out how we can deliver the lectures efficiently with the translation.  Hopefully a restful night is in store!

Room with a View!

'poco Ingles' has become my least favorite phrase...

Long day of travel and finally arrived in Miraflores.  I think it could be what one might considers an eventful trip.  On the flight to Lima, the kid in front of me had Blue Gatorade in his bag that happened to leak out of the bag, through the overhead compartment and in my seat haha go figure! Another exciting adventure...the woman sitting beside me fell into my headphones and drove them in to the seat outlet so deep the flight attendant had to use his fingernail clippers to get them out (it was either that or a report got written up for my seat!) needless to say they are broke so I have no headphones! Once in Lima, I proceed through Immigrations and customs, all the while keeping an eye out for Riccardo, an Essalud employee that was supposed to pick me up.  I had sent him my photo but never received one from him.  He does not hold up signs for fear someone will lie to him and say they are the person when they are not to get a free ride/hotel room.  Finally after 30 minutes of searching, a man approaches me and nods-I am assuming this is Riccardo.  He said 'Riccardo, el poco Ingles' and said what I made out to be wait one moment.  He left talking on his cell phone and returned to the lobby 30 minutes later!! I had no clue what was going on.  He negotiates a cab for me and leaves.  I get in the cab and the driver says 'El poco Ingles, Miraflores?' I replied 'si, and the hotel name' he had no clue.  So, I am sitting in the cab (they don't use traffic signals) going through a bunch of dark alley ways 'shortcuts' not having any idea if he knows where the hotel is.  Finally I look up and see the hotel...phew! It was a bit scary.  I will be at this hotel for one night then traveling to a different part of the city for the remainder of my visit.  Off to get some rest :)