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??????!!!!!!