Getting to know our hosts and community workers Sunday at the beach helped us to feel more comfortable today when we out in the community to do home visits for our first day of work. Ramona, one of the community health nurses, was our guide for the day. Since we have Dr. Pullen, a physical therapist from the school of medicine, with us, we concentrated on visiting patients who had a disability, were homebound, or in need of physical therapy. Ramona had previously identified the people with disabilities in just one sector of town. As Dr. Foster says, we feel like we are just hitting the tip of the iceberg, as there are over 380,000 people who live in the town. Just imagine how many other people are in need of physical therapy. As the day went on, more and more people called out to Ramona as we walked by their houses to ask Ramona if the “doctors” could see them, if we had medicine for high blood pressure, or telling us of a neighbor or family member who had been injured.
We were all amazed by the extent of the injuries we saw, most of them being the result of motor vehicle accidents. As the day continued and we saw more and more of these injuries; we started to look behind us and be much more aware of our surroundings walking down the street, looking out for cars and scooters. As we waited outside houses and walked down the street, the public health nurses in our group helped us to see the public health issues in the community and how some of these injuries and other health problems could possibly be prevented.
The quality of care these patients were receiving from their families in their homes had a big impact on us. Some of the patients had received surgeries, but many of them never had. Many had been referred to physical therapists, but since there aren’t any in the town, this was not a realistic option. Patients were so well taken care of by their families; they were very clean, well dressed, their family members took them out, helped them get out of bed, turned them, we did not even see a single pressure ulcer. The patients looked much better than many of the patients we have seen in the hospitals in the US. After seeing the hard work that these caregivers provide, we started to not only assess the patient, but also the caregiver, and were able to work with them on proper body mechanics and provide them exercises they could do to prevent injuring Britain
On one visit, we worked with a 12 year old boy who had cerebral palsy. His mother had abandoned him as a baby and his grandparents were his primary caregivers. His grandmother had been in an accident and the family did not have the money to amputate her foot, so she had been living with an ulcer on this leg off and on for 8 years. She could barely walk on this leg, and since her husband worked during the day, her other grandson who is 13 years old provides much of the care for his brother. Although it was somewhat hard to think about a 13 year old boy (who in our opinion should be out playing with his friends) stuck inside caring for his brother, it was really beautiful to see the connection between the two brothers and to see the younger brother with a big smile watching his older brother performing his exercises. We learned so much today from these home visits, about the kinds of injuries people in this area suffer from, the care that is available, and the important role families play in the care of these patients.