Week Two – Thursday's Blog

/in /by CAMTA

(Left to Right) Adult Ward Nurse Jum Hemmerich, Logistics and Translator Sammy Ruiz and Pediatri Ward Nurse Dianne Cortez with pediatric patients Jerssy and Emilio. Both patients were discharged, and are going home today. 

 Physiotherapy in the Ward
 
Regular exercises to restore normal hip motion and strength are important for full recovery after total hip surgery. Physiotherapists teach many exercises that are important for increasing blood circulation to legs and feet to help prevent blood clots. The exercises also are important to hep strengthen muscles and improve hip movement. 
 
Patients begin these exercises in the wards shortly after surgery. At first, the exercises feel uncomfortable but if done routinely, the exercises help speed recovery and also reduce post-op pain. The exercises are done by the patient lying on their back with legs slightly spread apart.
Physiotherapist Brenda Corie with 52-year old patient Augusto. Brenda is helping Augusto with a bed-supported knee bending exercise.

Some of the post-op exercises demonstrated above by physiotherapists Brenda and Kristen include Ankle Pumps which involve slowly pushing your foot up and down. Another exercise is a Knee Bend which involves sliding the heel of the foot and bending the knee while still keeping the heel on a flat surface like a bed. Lastly, Straight Leg Raises are done to tighten thigh muscles. In this exercise, the knee is kept straight, and the leg is lifted a few inches off the bed and held in the raised position for about 5 seconds and then slowly lowered back down. 

Completing these exercises routinely will help complete the healing process and allow the patients to return to everyday activities. 

Pediatric patient Damares Estafaniais a 3-year old girl with Cerebral Palsy (CP). Both her hips were starting to dislocate so surgeons released tendons around the hip so that she can walk better and to prevent her hips from dislocating at such a fast rate. Damares returned home today after her surgery. 

Three year old Damares Estafania smiles in the Pediatric Ward after her bilateral hip surgery.

22-year old Ronny Steven has Osteogenesis Imperfecta (OI), a disease in which the bones are very weak. Children with this condition get many fractures easily because bones don't form normally. This is a genetic disorder. Ronny has had 24 previous surgeries to treat his fractures and keep his bones straight in the legs. He came to CAMTA because one of the rods from his previous surgery was starting to protrude out of his bone and causing him a lot of pain in his knee.  The best treatment for this condition will be to correct the deformity in his femur, however this would require a specialized nail which the surgeons did not have access to in Ecuador. CAMTA surgeons were still able to help Ronny by shortening the nail he already had in his femur and repositioning it so he would not have any more pain in his knee. CAMTA will consider bringing a nail on the next mission to treat Ronny's deformity.

Twenty-two year old Ronny Steven with CAMTA volunteers (left to right) Medical Student Sarah Roshko, Translator Tim Smith, Pediatric Ward Nurse Julie Cadrin and Physiotherapist Kristen Redhead.

 

New Patients Mid-Week

 
Sometimes, patients are not able to make it to Clinic Day for a consult and instead arrive at the hospital midway through the week. All the steps of the Clinic Day must still be followed: patient registration, consult with a surgeon, anesthesiologist, a GP if required and a nurse who completes the patients' nursing history. The CAMTA team tries to accommodate these patients, however, this is not always possible. The complexity of the cases and availability of resources such as CAMTA volunteer staff, O.R. and Ward space and supplies must be thoroughly evaluated before patients can be accepted mid-week. When the schedule is first put together, the more complex cases are scheduled for earlier in the week because these patients may require extra recovery time. Therefore, when patients miss Clinic Day, and are complex cases, it becomes difficult to accommodate them. 
 
When new cases are accepted mid-week, the surgery scheduled for the remainder of the week have to be reviewed and re-scheduled. This involves a multi-discipline team that includes the medical team and administrators to complete required paperwork. Social worker, Nellie, then informs all affected patients of changes to the schedule. 
 

Eight year old Alexander Samuel's right leg is turned inwards significantly more than his left leg. This creates asymmetry in walking and makes it difficult for him to kick a soccer ball. Alexander has been offered surgical treatment that involves cutting his right leg bone and turning it outwards. After surgery, Alexander will stay overnight to recover and is expected to return home the next day.

Eight-year old Alexander Samuel shows us his soccer skills in the pre-op area. Alexander missed Clinic Day earlier in the week, but his case was assessed on Thursday and his surgery was booked for Friday. Alexander kicks the ball from the outer side of his foot because of his condition.

 

Sadly, not all patients can be helped. Seventy-five year old Zoila Rosa missed clinic day at the beginning of the week. When her x­-ray was examined by an Adult Orthopedic Surgeon, it was determined that she needed bilateral hip surgery. Given the complexities of the case and the fact that she had some problems with her heart, CAMTA could not help Zoila Rosa. Zoila Rosa lives in Ambato, a city about 3 hours away from Quito, has 5 children and 13 grand-children. Her hip condition makes it difficult to sit or stand for long and also causes pain through the night which makes sleeping difficult. CAMTA has invited Zoila Rosa to return next year on Clinic Day so that she can be examined again and perhaps be  accommodated towards the beginning of the week. 

Seventy-five year old Zoila Rosa with her daughter in law, also missed Clinic Day. Due to the high volume of Adult cases, and the complexity of her case, Zoila could not be accepted this year. She has been invited to return to the CAMTA clinic in 2016. 

 
Six year old Alexander Antoni has cerebral palsy (CP); his right ankle motion is very limited which makes it difficult for him to walk. Alexander was accepted for surgery. His treatment will be a minimally invasive procedure to lengthen his ankle tendons. He will be placed in a cast and will likely be sent home the same day.

Six year old Alexander also missed Clinic day, but he was accepted for surgery mid-week. In this photo, Alexander and his mother meet with Pediatric Anesthetist, Dr. Kate Fry and translator Francisco Gallardo.

(Left to Right) Logistics and Translator Sammy Ruiz, Computer Person Greg Zinter and Layperson Sandra Muchekeza complete paperwork for the new patients accepted for surgery mid-week.

By the end of Thursday, 18 Total Hip Replacements and 15 Pediatric surgeries have been completed by the Week 2 surgical teams. Many of these patients have already returned home while some are recovering in the wards and will be discharged in 1 to 2 days. The patients and families are very grateful for the high quality of care they have received from the CAMTA team.