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Learning to walk on LEGS
The last two weeks have been full of challenges and worthwhile activity. Ricc Gonzales especially has been pushing hard. Three amputees who have been wearing the LEGS knee for several years returned on May 19th. These were Peter, who lost his leg due to a hippo attack, Kenneth, and Joseph, an older man with a kind disposition. Peter walks up to ten kilometers a day and his knee was worn but still functional. Ricc let us know that any prosthetic knee in the world would likely need to be replaced after that kind of wear, so the fact that it was still functional was good news. We gave him a new knee and we’ll be bringing his old knee back to the U.S. for analysis.
It turned out that the first three returning patients all needed new sockets. Ricc let us know that even in the United States in a well-equipped prosthetic clinic, it can take a week to perfect a new socket. But that week, there were three to get done. On top of that, the prosthetists here are eager to work with and learn from Ricc, and the general pace of work is definitely African, which is of course normal since we are after all in Africa. However this meant that in spite of pushing hard, all three revised limbs couldn’t be ready by Friday. Our students, Jason and Ryan, have worked hard with the men in the brace shop, and Katie worked with Tasha using the skills she’d learned to do the first week to help with orthotic work and so free up more time for the brace shop personnel to do prosthetics. The team stayed late on Friday night to complete Kenneth’s leg because Kenneth needed to be back in school on Monday. Joseph and Peter stayed over the weekend.
During the time they were here, Megan was working with them daily teaching strengthening, stretching and gait skills using their existing limb. Micheal, an occupational therapist from AIC CURE’s rehabilitation department, worked with her improving his skills and knowledge in working with amputees. By the end of the week, Micheal was leading the exercises; he’s continued to do so for the new amputees this week. Because of the time crunch, Megan didn’t have much time to work with either of them after they were walking on their new limbs. In spite of the time pressure, Katie and Tasha were able to complete the collection of outcomes measures for all three men.
The night and day we spent at Nakuru National Park was a much-needed break from the pressure of trying to get a job done in what was essentially too little time. When we got back, we revised the schedule in a way that hopefully will make our tasks more doable.
On May 26, Isaac arrived, our first new patient this year. Isaac has never had an artificial limb before. He’s here with his brother, both of them in their 20s and a lot of fun to be around. On May 27th Benai arrived. Benai is in his 60s and has been using a Jaipur leg that behaves like a peg leg while he is walking. Benai has a very short residual limb and is also missing one arm. Both are excited about having a leg with a knee that will allow them to walk more normally.
Walking well with the LEGS knee is a learning process. It will be a challenge for Isaac because he has never walked with a prosthetic leg; it will be a challenge to Benai because of his short residual limb, his age, and because he’s been walking with a limb that acts like a peg leg. The two of them are staying over the weekend to spend time working with Megan and Micheal next week.
On the afternoons of May 29 and 30, Megan gave a seminar on rehabilitation for amputees. It was well attended. Carol, another occupational therapist who works for AIC CURE, came back from vacation to attend the seminar. Rehabilitation personnel from Kijabe hospital, the large general hospital nearby, also attended. It was great to see Megan pass on her hard-won knowledge on amputee rehabilitation. Unlike the seminar in Sierra Leone, this was not a LEGS seminar which directly concerned only amputees fit with the LEGS knee. It was a service Megan provided to AIC CURE and others who work with amputees.
In addition to all the work with amputees, I’ve had some great planning meetings with AIC CURE leadership including Dr Tim Mead, Dr. Joseph Theuri and Jack Muthui. Next year, if preparation and arrangements work out, we are tentatively planning to hold a transfer of technology seminar here like the one Dr. Roger Gonzalez held in Sierra Leone this summer. It’s a privilege to work with those serving God by working at CURE.
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Technology Transfer Workshop
Today we wrapped up the first ever LEGS Technology Transfer Workshop here in Freetown, Sierra Leone. After four days of training, the nine participants from the three non-governmental organizations, or NGOs (Mercy Ships, Prosthetic Outreach Foundation, Handicap International), all felt as if they were given a new tool to meet the needs of their fellow men who have to suffer life without a limb.
During the last four days, we had each participant build two LEGS-M1 knees and demonstrate that they can adapt it to their existing socket and foot technologies. Each organization fit one amputee. Each amputee felt it allowed for a more natural gait.
I asked the NGOs to move forward in implementing our knee on a limited basis (6 to 12 patients over the next 12 months) so we can have a chance to address any unforeseen problems they have as they may arise. They are very eager to share what they have learned with their colleagues, but I communicated that it is best for them to become proficient in the manufacturing and adaptation before we move toward the next step—empowering them to become the trainers.
Implementing new technology takes time and must be phased in. LEGS is moving toward the next step of eventually turning the entire knee project over to local control. Our motto “teaching a man to fish” is becoming more and more of a reality. During this trip, we observed them catching and enjoying their own fish this week—allowing LEGS to reach more amputees.
LEGS will return to Sierra Leone within the year to evaluate the extent of our success with our newly developed technology transfer workshop. We have some improvements to make, but overall, the workshop we provided was a success and very well received.
I will go to Kenya next to evaluate our progress there. Micah Casteel, a recent LETU graduate who spent three years on the LEGS team and who worked with me here in Sierra Leone during this trip, will return to the United States to get married. Micah has been a great asset to LEGS. It is time for him to move forward to earn his Ph.D.
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First-time hovercraft ride
We arrived in Sierra Leone as planned. Riding in a hovercraft was a first for me in my international experiences - and it beats a helicopter ride.
Today we started off the day with a opening ceremony and speeches by both the Head of the National Rehabilitation Center of Sierra Leone and me. We followed the opening ceremony with tea and a 90-minute overview of LEGS with a lively Q&A session with the prosthetist from the three NGOs (Non-governmental Organizations). We were happily surprised by the number and intensity of the questions the teams were asking.
They brought up many of the major issues that LEGS is still facing: materials sourcing, cosmesis (how the prosthetic looks cosmetically), durability and locking concerns. I think we were able to satisfy their questions. They seemed impressed when we explained our trial cosmesis knee-covering pioneered this year in Bangladesh (props to the Bengali guys for the kneecap experiment).
In the afternoon, student Micah Casteel took the lead as we moved into the practical demonstration of our presentation. We were promptly sidelined by a broken bandsaw blade. It exploded in cinematic fashion and startled nearly all attendees. After an hour hiatus of locating a band saw blade and servicing of the machine, we were back up and running and made good progress with training.
By the end of the day, we had nearly finished the bottom block as training accelerated throughout, which led me to believe optimistically that we should be able to complete everything we set out to do on this trip.
I am looking forward to a good and productive day tomorrow.
On a personal note, a loud thunderstorm hit the city here at about 3 a.m. as we are in the beginning of Sierra Leone’s rainy season. The sound of the heavy rain on my tin roof was a memorable experience.
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Talented craftsmen
This week we are teaching the head technician how to use the jigs the engineers made. The men who work in the shop are very talented craftsmen. They pick up on tasks incredibly quickly. If they do not have a tool that you think is necessary, they find a suitable substitute almost immediately, and it is never what you had in mind.
The work week starts on Sunday here. Friday is the holy day of the Muslims, so that is when Christians go to church. Saturday is a day to rest. Work is Sunday to Thursday. On Sunday, Prodip and I made a knee. Wes let me do the teaching, because the manufacturing guide is made for anyone to understand.
If a pre-med major can figure it out and teach them, then they are set. Prodip and I had no problems. By the end of the day we had a fully working knee. For the rest of the week we’ll be making knees to prepare for the new pts (patients) we’ll have next week.
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The work begins
We’ve worked with the pts (patients) for two days now and it has been really good. Four pts were fitted without the LEGS team being here, three men and one woman. We were surprised to find out that the woman is three months pregnant, making her the first pregnant amputee to use our limb. We finished most of the pt histories and other paperwork we have to do and have begun gait training. Their gaits all look very good.
Anytime there is something to correct, they all work very hard to get it right. While one is working, the others are taking notes so they can get it right the first time. They also help each other out and give each other pointers.
Soon we are going to begin teaching the technicians in the limb and brace shop how to make cosmesis, then the pts will learn to walk with those on their prostheses.
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A young man missing his leg
Yesterday, Samuel came in. He’s a 15-year-old boy missing his leg above the knee. He’s not one of the amputees we were planning to fit in two weeks, so the chance to come alongside the staff here as they worked with him was just serendipity. It was really exciting to see Ricc and Megan work with Ogutu and Jonah to assess him and teach him exercises and wrapping techniques to prepare for fitting.
Katie has been working with Ricc and Jonah as they do orthotic work. She plans to go to graduate school for prosthetics/orthotics when she graduates. Yesterday, under Ricc’s supervision, she made her first orthotics and fit them only a tiny three-year-old called Martha. That was fun to see.
The bandsaw is functional now, and Jason has been working with Ogutu and Jonah to build the LEGS M1 knee using the ne, more precise method.
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Arriving in Kenya
Megan Bell, Ricc Gonzales, Katie Leatherwood, Karen Rispin, and I arrived in Nairobi, Kenya, late Saturday night (5/10/08) after flying from Dallas to London and then from London to Nairobi. Katie and I are LeTourneau students; Mrs. Rispin, teaches biology at LeTourneau and is the faculty member traveling with us. Ricc, a prosthetist, and Megan, a physical therapist, are professionals from the Longview area who are volunteering to collaborate with LEGS.
In London, we had a scare when Megan left her passport on the airplane, but she was able to run back onto the airplane and retrieve it.
In Nairobi, we stayed overnight with Marv and Jan Smith, missionaries who worked with LeTourneau as missionaries-in-residence for two years. They took us to a local church Sunday and then to an Ethiopian restaurant. The church service lasted two hours, which is short for their standards. The service was very cool. The couple also gave us a good orientation to the Kenyan culture.
We got in to AIC CURE hospital at noon Monday. Returning patients will come next week, so this week will be spent preparing. Ricc and I worked in the brace shop. I am teaching the Kenyan staff how to build our prosthetic knee using a new method the LEGS team devised this last semester. Ricc is sharing his expertise. Megan started working with a German physical therapist in the children’s hospital. Katie started setting up our equipment for outcomes measurements.
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My first patient
Kijabe is still treating me very well. Yesterday I tested all of the outcomes measures equipment to make sure it all works. I did a few trial tests and everything came out well. I have set up our testing in the new building that will be an operating center. Last night Megan, Jason, and I went over to Tim Mead’s house (medical director), to “rent” a movie. Each evening we have a team meeting talking about what we accomplished the day and our goals for the next day.
This morning I once again awoke to the amazing view of the Rift Valley. Not sure of what I would do today, I prepared for a busy day. We began the day with a chapel with all the leadership of the hospital. It was really good. The African people can sing. Even though I cannot understand Swahili, they sound amazing!! After chapel, I went to the brace shop to see what was in store for today. My name in the brace shop is Sapoe (sp?) meaning beautiful girl…ha-ha.
Ricc let me help him fabricate 2 forms for a little girl’s leg braces. It was my first experience in orthotics. I learned to make the plaster and form it to the mold. It was so fun. Mathu, a Kenyan in the shop, let me help him throughout the day work on the braces. He is the chief orthotist and taught me a lot. I was able to start from the beginning of the mold until the braces were complete. I formed the plastic until they were ready to be fit to the little girl. The patient was a three-year-old girl named Martha. She was the cutest patient ever!! It was amazing to see her leave the clinic with new leg braces.
Besides fitting Martha with braces, we also got to see our first prosthetic patient. He was a 15-year-old boy named Samuel. I had a chance to test out the forms and fill out information about him and his stump. He will be coming back in 2 weeks to be fit with the LEGS knee! It will be his first prosthetic ever, and he has been without a leg for 7 years.
The team is getting along really well and beginning to bond. We have met many new people around Kijabe station that have amazing stories. We even saw monkeys today! Please continue to pray for the team and the patients we get to help!!
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Camel milk and cell phones
The sights and smells of Kenya bring back powerful memories. I’m home where I grew up. So much is the same, but so much has changed. Kenya now has its own version of Wal-Mart called Nakumat where one can buy almost everything from camel milk to cell phones. Monday we left crowded, noisy, energetic Nairobi and came to Kijabe where we’ll be working, and where I went to boarding school as a kid
Jason, Katie, Megan and Ricc are fantastic. Already they’re singing in Swahili, drinking milky sweet chai and digging in to their own tasks. They go above and beyond. Ricc has helped to fix the oven. Jason has been working on an internet router. Katie has set up cell phones for us to use locally, and Megan is putting in extra hours with the AIC CURE rehabilitation staff. God is good!!
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Arriving in Bangladesh
Wes, Micah, and I made it to Bangladesh with only a few close calls and one bag with a side pocket broken open. Upon arrival in Chittagong, all five bags met us a little worse for wear. One bag had its side pocket zipper broken and was tied closed with the shoulder strap. We think the bag broke open in LAX (Los Angeles International Airport), as there was a TSA (Transportation Security Administration) label greeting us from inside that pocket. Luckily, only two blocks of Delrin(r) (plastic) fell out of the bag. We made it through customs with little incident and were greeted by Heather Fowler.
Introductions were made and we hopped into the van, the three of us eager to finish our travels and find a place to sleep. The trip from Chittagong to Malumghat took at least three hours. We arrived at MCH (Malumghat Christian Hospital) at ten minutes to six, just in time for dinner. After dinner, the three of us crashed, our travels and trip preparation had wrung us dry; we were ready to sleep.
When we awoke the next morning, we decided to go see if anyone who could give us a tour was at the hospital. Micah, having been here twice before, led the way to the hospital. At the hospital, we met Tuhin, the head PT(physical therapist). Tuhin went to find Lisa, an expatriate nurse who was on call so she could give us a tour of the facility.
The facility is a single-story building with open-air hallways connecting all the different rooms. Equipment in the hospital can be found from almost every era. In the OR (operating room), a brand new, almost top-of-the-line vital signs monitor stands out against the ancient operating table. The hospital has two X-ray machines and a well supplied lab that may be the best in the country. The lab, OR and X-ray areas are the only areas of the hospital that are air conditioned, mainly because of the sensitive equipment.
After our tour we had tea with Tuhin and decided when we were going to start working the next day. Sunday we will begin working with the patients that MCH has fit on their own while we’ve been gone.
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I am in Kenya!!!
Africa is AMAZING!!! The picture above is the view I wake up to every morning. Our house sits on the edge of the Rift valley!! I am here with the LEGS team in Kijabi, Kenya. We arrived in Kijabi yesterday afternoon after being in Nairobi for 2 days. In Nairobi, we spent 2 nights at the Smith’s house and drove around Nairobi looking for LEGS supplies. Now in Kijabi, we are preparing for the patients to come.
The first group of patients arrive next week. Until then, Jason is training the Kenyan prosthetists to manufacture the LEGS knee using the new jigs and procedure. Yesterday we spent the day becoming acquainted with the Kijabi station and meeting people we would be working with. The people are very friendly and welcoming. All the guys of the brace shop are very open to our training them on the LEGS knee. Today I spent the day helping where needed. This week is mostly for Jason to train the prosthetists on the LEGS knee. The real work begins next week. I set up the location I will be administering the outcomes measures with the patients. It is lunchtime now, and the team is taking a break. The Internet is not very reliable but I will update when possible. Keep praying for our team’s safety and health.
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Destination: Kijabe, Kenya
School is over and final preparations are continuing as the LEGS team prepares to send 3 teams out into the world. I will be leaving on May 9 with 3 other LEGS members to Kijabe, Kenya. Please pray for safety, health, and guidence. The time will be busy and full of adventuresI will return back to the States on June 22. Please check back often for stories, updates, and pictures!! Also, feel free to leave comments. Below is a link to a PDF of a detailed prayer guide for the LEGS Team. Please take time to look at it and pray for the team. Your prayers are greatly appreciated and needed!
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