Written on 5/10/10

Bilateral transtibial/transfemoral patient

Ok, so I've just finished my first real day of work. We had a bilateral patient, though he turned up really late, like 3 hours late, but that's fine. Transport isn't exactly the easiest thing to get by with here. So he came with two prostheses that had been sent over from a western country, and then had a socket made here for him to fit (this was all in another centre elsewhere in Uganda). When he arrived, his transfemoral leg had his toes pointing about 45 degrees inwards which looked really uncosmetic. The aim for today was to basically fit two new legs that had been made for him, but it became apparent that when we tried them on, whoever had made them had made the left about 6 cm too long. The socket was also a really loose fit, so he moved around in it. Therefore the idea was put forward to re-cast him properly. The only problem was that if we made him  new legs, then the ones that we would be giving him would be a far more basic ones than he currently has. I suggested that we just fix the toe problem that he has at the moment so that he can keep what he's used to, rather than moving him in a backwards direction to a cheaper leg made of drainpipes. (The transfemoral side was made of carbon fibre!). We casted him anyways as a pure training session for the two prosthetists here, and I demonstrated the way were taught in Uni'.

BUT, it wasn't all as simple as that. Once again, poverty raised its ugly head, and we soon realised that in order to rotate that foot outwards and back to its normal looking position, we would need a ring spanner.  After looking in the only tool box, we found that we didn't have one. We tried turning the bolt with a pair of pliers, but after 15 mins, our efforts were fruitless. We were almost ready to give in, when before I knew it, we were dismantling a huge drill and crushing a pipe in a vice around a similar sized nut to create our own spanner. Amazingly, this industrious idea seemed to work and we were able to remove the bolt, rotate the foot and then re-position it back in place with it tightened as best as possible. The patient seemed happy with the results and he went on his merry way. The creativity here with what they have is excellent, though we would have saved an easy hour if we just had that simple spanner - something that we take so much for granted in workshops back home. On another note, I was amazed how well the patient walked, especially considering that he was bilateral transfemoral/transtibial and walked with a locked knee joint.

New transfemoral patient

Another patient arrived today that Dr. Wanume had brought back from his clinic. He was an elderly bi-lateral amputee, losing his leg due to gunshot. He had never had a prosthesis in over 6 years (when he sustained his injuries), so Patrick and Fred showed me their version of casting, which doesn't seem all that dissimilar to my method. We also spent a few hours going over some basic transfemoral revision of suspension techniques, socket designs and concepts and touching upon some upper limb theory - though they don't see any upper limb patients here.

It's been a great experience and the patients have been so refreshingly thankful and pleased to receive any sort of treatment. I'm really beginning to enjoy myself here, and everyone is so friendly, especially here in the centre. The other prosthetists (or technologists as they prefer to be called) have been teaching me little bits of Swahili and Ugandan, though I'm pretty rubbish. They keep reminding me of the different name of fruit, plants and trees that grow here in the garden, and names are gradually beginning to sink in a bit. The food is pretty tasty too, though I must admit that it's a first for me to have both spaghetti, rice and mashed potato all sitting next to each other on my dinner plate. They tend to cook a lot of different stews, beef and fish being the most common, with maize and a fruit called Matokay (not sure how to spell that) from the banana family that's heated and mashed up. Its all good stuff and I've not had any     *ahem*    traveller's troubles as of yet….